By Cindy Atoji

Feb. 12, 2008 | Tenet Healthcare has faced its share of recent financial woes, but this acute-care hospital chain sees clinical information technology as one of the solutions to managing costs while enhancing quality of care. Liz Johnson, Tenet’s vice president of clinical informatics, has helped lead the company during the implementation and deployment of multiple clinical systems across several hospitals. Today the clinical application suite of products for Tenet’s 72 provider organizations includes over 3,000 clinical applications and 5,000 custom interfaces. Johnson is also on the board of director of HIMSS (Healthcare Information and Management Systems Society).

Digital HealthCare & Productivity recently spoke with Johnson about Tenet’s team-based approach to process redesign and how to develop a comprehensive clinical informatics vision and strategy.

DHP: Tenet has made significant progress in delivering physician-friendly tools, from physician portals, PACs, scheduling, and document imaging. What’s the thinking behind this clinical information roadmap?

Johnson: We’ve chosen a strategy that enhances the foundation of applications across various ancillary departments and facilities, whether it’s pharmacy or radiology, to interface electronically and make the information more congruent across the database, closing the loop with information systems talking to each other.

DHP: Based on your experience at Tenet, what are the steps that need to be taken to reinvent clinical processes to best leverage information technology to deliver safer and more efficient care?

Johnson: Some of the most significant failures on deployment that I’ve seen are when the IT department drove the change, and the clinicians were the recipients. When you look at the future and how you will deliver care, the first thing is to make sure that you involve the clinician and determine what processes can be supported by technology. The clinician needs to drive the process, not the other way around.

And then you need to document the process that you’ve agreed on. For every department, we created visual maps of the steps that take place and how technology can interact with that and become part of the normal workflow.

We used real-live scenarios, for example, of a patient going through the hospital- care continuum, and with the clinicians, tested our processes against this to see if it will work. Once you take it live and into production, there will be modifications.

DHP: In your experience, how extensive do those modifications need to be?

Johnson: What we typically find is that modifications are not extensive — it is more about tweaking than rewriting or redesigning. When you involve clinicians from the beginning, they are articulate in explaining how their processes flow. If you match the design to this, they will catch the pieces and parts that don’t work the way they thought it would. We show actual computer screens — we don’t just talk about how it might work.

DHP: How can a hospital make its doctors and patients comfortable with the greater use of IT within the care environment?

Johnson: This is not like putting in a materials management system. Clinicians are very geared to think first about patient and patient safety. Whether across a single or many hospitals, we pulled together groups of clinicians and set out guiding principles and then prioritized them, taking them to the detail level, writing standards and documenting them for every single department and application within a department. Then we brought in the technology people and application specialists who could help the process be more thorough, more nationally based, and other factors. It’s a long and judicious process.

Hospitals don’t work in silos but work together to deliver care. It’s not a static process —often new regulations, new best practices, new care processes need to be considered.

When you’re dealing with multiple entities, bringing in a cross section of your enterprise representation is critical. If you allow one hospital or region to make all the decisions about a particular application or standard, you’ll miss state law differences and regional preferences. You need to create a consensus.

DHP: So, has Tenet seen an ROI on the clinical systems it has implemented so far?

Johnson: As you know, return on investment related to clinical systems is very difficult to measure, although there are some systems that yield measurable outcomes. A centralized scheduling system will allow you to move the patients through the organization in a more efficient and productive way; laboratory, radiology, pharmacy systems allow you to eliminate duplicate orders and provide cost avoidance. And eventually I believe our systems will reduce length of stay. The challenge we have with clinical system is that there are so many variables that contribute to outcome and to the length of stay.

DHP: You’re on the board of directors for HIMSS. What’s on the radar screen for this organization?

Johnson: Similar to what we’re doing here at Tenet, we’re recognizing that that there are many groups using technology, and we need to provide venues where you can learn about this, especially for clinicians, whether it be bar coding, privacy, or issues related to interoperability.

HIMSS is also a place where you can look at what’s going on in the national arena with regards to coming legislation.

And we’re also going international. There’s such a desire to understand what other countries are doing in information technology in the clinical and business arena. Now we’re not only operating in the United States but in multiple countries.