LEE- Medical Library5

CheckUpVol. 5, No. 19Jan. 22, 1993 Coming Soon, to a Computer Near You...

"And do you have any allergies?" the clerkinquired.

The exasperated patient had been countingthe number of times he was asked the ques-tion. "For the fourteenth time, no," hegrumbled.

It sounds like a small point, but to the patient,and extended throughout the scale of anindividual's medical record, its an example ofthe enormous inefficiency of paper records.

At the end of March, it's all going to change.

Right now, hospital departments and Informa-tion Services are putting the finishing toucheson a year-long effort to make an extremelycomplex switch to electronic data storage. Itwill have far-reaching ramifications, all ofthem positive, for staff, physicians and most ofall, patients.

What patients will get is much improvedservice in a lot of little ways that can be verymeaningful. The gentleman being askedabout allergies will only have to be asked once,because with the new system, the response isautomatically posted in all the correct places.

Diets can change on very short notice, some-times after the patient tray line has the paperorder in hand. Medical alerts will notify staffof conflicting orders.

But on a far more serious note, PCMA cansave precious time in crisis situations. Anexample is a woman with a specific medicalcondition discharged after the birth of a baby.Several months later, she's brought to ShockTrauma after an accident.

Under the present system, the immediateContinued

Gates Nearly Ready to Go at Employee LotsWith all the gates installed, it won't be longbefore employee access to all parking areas willbe controlled by identification badges.

E. Gerald Kresge, director, Security, antici-pates that gates will be down and operationalon Feb. 15 to appropriate parking areas.

He explains that each employee badge isencoded to open gates, and behind the sceneshis department has been entering data on eachbadgeholder into the computer system thatactually operates the gates. It means thataccess will be limited to specific lots, dependingon shift assignments.

The concept of fully managed parking hasbeen in effect at 17th & Chew for some time,and among the benefits of constant lot moni-

toring is the ability to continually fine-tuneparking assignments for the convenience ofhospital staff.

The parking lot arrangement at Cedar Crest &1-78 is not expected to change very much untilthe Morgan Cancer Center is completed in thefall. That's when the grave1lot at the west endof the site will cease to exist and the paved lots,now well-defined, will absorb the volume.

Kresge had praise for the efforts oflot atten-dants in helping staff and visitors adjust to thenew system, particularly in directing employeesto designated areas to maintain plenty of spacefor patients and visitorsin lots closest to thehospital.

I

Continued fromPage 1

••

Coming Soon, to a Computer Near You...response must be based on "new patient"protocols until her medical records are re-trieved from storage. That can take hours.

Under the new system, electronic records canbe searched for her name, her full medicalrecord is available in seconds, and appropriateaction can be taken.

The difference is the technology available incomputer systems being married to thetechnology throughout the hospital, and itlargely means no one has to wait for a piece ofpaper with important information to movefrom diagnostic areas to units or units topharmacy and food service.

Because lab results, for example, go directlyonto the electronic record, they are instantlyavailable for study by attending physicians.Additionally, it means the chart is no longerphysically wedded to the patient, travellingwith the patient to, say, Radiology. As theexample goes, a physician may stop by tocheck the patient's record, but at present couldnot see it because it's off with the patient.With PCMA, the physician can review patientprogress at any time, and not just on a specificunit. It could be from any terminal .

But not just anyone can take a look. Animportant part of the system is a means forallowing access to the patient record onvarying levels, depending on need to know.For example, test results from clinical labs canbe posted to the record, but the record can't bebrowsed.

One of the major challenges over the past yearwas to adapt a basic package from the vendorto the specific requirements of Lehigh ValleyHospital. Even then change was involved,because such familiar phrases as "STAT" havedifferent connotations throughout the system.

Establishing common standards from differenthospital sites, deciding exactly what was mostfunctional for those who use the system,testing and then establishing training pro-grams have made for a hectic year atInformation Services.

And although an exact date hasn't been set,there will be a point around the end of Marchwhen patient record keeping changes in oneswoop. The reason is straightforward: at somespecific point, the entire computer systemswitches over. It can't be done halfway.

Lingo: Some of the Common Terms You'll HearThere's a thicket of terminology surroundingthe new computer technology to improveservices involving patients. Here's a briefglossary:

PCMA - Patient Care, Management andAccounting. This involves clinical things liketest results and observations, which is the C;admitting, room assignments and so on, which

. is the M; and financial matters, which is the A

PHAMIS (sounds like "famous") - This is thevendor who received the contract to work withLehigh Valley Hospital to establish the newPCMA system.

Lastword - The name of the software that'sbeing used on the new computer, modified to

meet the hospital's precise requirements.

LAN and WAN - Local Area Network andWide Area Network, which is how all theterminals are going to be hooked up to talk toeach other. The difference is the size of thearea covered. In more familiar terms, a localarea network is every telephone extension inthe hospital and a wide area network is everytelephone in the 215 area code.

E-Mail- Through the personal computers,messages can be sent directly to someone elseover an electronic network rather than bytraditional interoffice mail. It's short for"electronic mail."

Page 2

Futures Tackling the Tricky Issue of Surgery SchedulesIt's one of the most complex and complicatedissues for any hospital. But when more than20,000 surgical procedures have to fit into 22operating rooms each year, there's a verydelicate balance between smooth operationand chaos.

Smooth functioning surgical services is a toppriority at Lehigh Valley Hospital and thelatest in a series of Futures projects to improveoperations.

A revised surgery schedule is tentativelyscheduled to go into effect in February,following months of study. The goal ismaximum efficiency of OR resources andsupplies and to increase patient, physician andstaff satisfaction

Scheduling surgery has, over the years,evolved into a patchwork system that oftencreates waiting for patients, surgeons and staff

".'herewas a time when the answer would bejust tocreate more OR space and staff, but that's an escaperoute that only serves to continue driving the cost ofhealthcare up and up.

~

at the start of the day and runs long past theplanned end of the day.

Bruce Gresh, director, Management Systems,points out that OR scheduling is an enor-mously complex business. It begins withcapacity - that is, the total number of proce-dures to be done match with the availablespace, staff and equipment. But it gets compli-cated with grouping varied types ofprocedures, which involve highly specializedstaff and equipment.

Adding to the challenge are time blocks forthe groups of surge oris to do their work.Traditionally, doctors are given specific blocksof time in specific operating rooms based ontrends of their caseloads.

And what complicates matters even more isthat the hospital has ORs on two different sitesand some physicians practice at all sites.

In managing surgical services, that's only thebeginning.

Even with the most elegant schedule on paper,operating rooms must be cleaned and ready,the patient has to be ready, the surgical teamready, and the necessary supplies on hand -all at the right time. Anything that's not inplace delays what's called "start time, " and adelay for one procedure affects the next,compounding through the day and ultimatelydemolishing the delicate balance of schedul-ing.

There was a time when the answer would bejust to create more OR space and staff, butthat's an escape route that only serves tocontinue driving the cost of health care up andup.

Seeing an opportunity for improvement,Samuel R. Huston, president and CEO, used ateam approach to seek out the best and mostworkable approach to the problem.

A team involving medical staff leadership andhospital administration began looking intoroot causes of difficulties and found shortcom-ings in several areas. A signficiant issue was"who's in charge" of the entire process. Agoverning board composed of the chairman ofSurgery, chairman of Anesthesia, and seniorvice president, Patient Care Services, evolvedto manage surgical services.

Another corrective action team focused onscheduling needed by surgeons to completetheir surgical cases. Information was collectedin two ways: historical use by physicians andphysician time preferences for block times.One group practice might, for example, prefertime on Monday and Wednesday morningsbecause of their office schedule. Anothermight Want Thursday afternoons, and so on.

Allowances for urgent cases had to be built in,

Continued

Page3

I

Futures,continued fromPage 3

Tackling the Tricky Issue of Surgery Schedulesand a system of scheduling control was estab-lished. The goal is for all OR cases to bescheduled by one central office staff. Cur-rently Cedar Crest & 1-78 main ORs and theShort Procedure Unit are centralized. MainORs at 17th & Chew will be added shortly. Apilot program for "first case start" was testedwith Short Procedure, and improvementswere noted.

Future corrective action teams or pilotprojects will focus on turnaround time includ-ing cleaning and setting up operating roomsfor the next procedure, and supply usage witha goal of trimming cost through standardiza-tion.

In reviewing the approach to the Futuresproject, Gresh says it was a series of four basicsteps: issues identification, development of aconcept of what the future ought to be like,prioritizing issues, and setting up teams ofpeople who understand the problem to workon solving the problem.

The surgical action design team includedHuston, Paul E. Nurick, senior vice president;

•• About Our People ...A paper reporting on the incidence of hemor-rhage following colonoscopic polypectomy atLehigh Valley Hospital was recently acceptedfor publication by the journal Diseases of theColon and Reaum. The study was authored byLester Rosen, MD, division of ColorectalSurgery; David Bub, a medical student fromNew York University; Jmnes Reed ill, PhD,director, Department of Research; and SusanNastasee, surgical editor, Department ofSurgery.

The institutional study analyzed 4,721 patientswho underwent colonoscopy and polypectomyfrom 1987 to 1991 at the hospital and revealeda significantly low hemorrhage rate of 0.4percent. The results compared favorably to 15published studies that reported rates rangingfrom OJ percent to 6.1 percent with an

Mary Kinneman, senior vice president; WalterOkunski, MD, acting chair, Surgery; WilliamFrailey, MD, vice president, Medical Affairs;Alphonse Maffeo, MD, chair, Anesthesiology;Ramon Deeb, vice chair, Anesthesiology;Headley S. White, Jr., senior vice president,Medical and Academic Affairs; and othermembers of the medical staff.

The ultimate effect of the entire endeavor isbetter service to patients, improved relation-ships with physicians, staff and hospital andreduction in stress because their days arebetter organized.

As with any quality project, this example ofFutures doesn't really ever end. As soon as theformal plan goes into action in the mainoperating rooms, continual monitoring willlook for further improvements and adjust-ments. But like all good quality projects, thedirection is to avoid the temptation of a quickfix or addition of one more patch to the quilt.Instead, the idea is to look for root causes anr'use a team approach to create permanentsolutions.

average of 1.9 percent.

Jolly Porter, RN, BSN, was appointedperi operative administrator by the governingboard for Surgical Services. Her appointmentwas part of a larger reorganization of SurgicalServices to improve efficiency and enhancerelationships. Reporting to Porter will bePerfusion, Short Procedure, main ORs at bothsites, and other support staff.

Dolores Benner, Mf(ASCP)SH, has beennamed supervisor of both Hematology andCoagulation by David G. Beckwith, PhD,administrator and clinical director, HealthNetwork Laboratories. Additionally, MarieMingora, Mf(ASCP), will assume responsi-bilities of a technical specialist in Coagulatiorand Hemostasis.

Page 4

Spirit of Women

I

Majar Speakers Highlight Conference AgendaScheduled for March 18 and 19 at the HolidayInn, Bethlehem, Spirit of Women 1993 willfeature nationally known speakers and a widevariety of workshops on health, career andfamily issues. Initiated and coordinated byWomanCare, the event has been planned byrepresentatives from more than 30 communityorganizations, agencies and businesses ~s wellas individuals from throughout the regIOn.Meridian Bank and the Dorothy Rider PoolHealth Care Trust join WomanCare as majorsponsors of the conference.

"The conference will be a celebration ofwomen and their accomplishments," saysMarie Shaw, director, WomanCare. "It will bea source of information and an opportunity forrenewal and networking."

The event will be launched with a receptionand dinner on March 18 featuring a keynoteaddress by Pulitzer Prize-winning columnist,Ellen Coodman. In her popular syndicatednewspaper column, Goodman touches thelives and hearts of her readers. Her articlesfocus on families, women's rights, relationshipsand other timely subjects.

The March 19 morning program will featuretwo keynote speakers. Frances Hesselbein,who is also serving as honorary chairperson ofthe event, will talk about the enormous de-mands of career and family. Between her roleas president and chief executive officer of thePeter F. Drucker Foundation for NonprofitManagement, her service on multiple boardsof directors and her regular trips to universitycampuses, she's rarely in her Easton-areahome. Hesselbein's appearance is sponsoredby Muhlenberg College.

Kicking off the afternoon session is JayneTear, a pioneer in the field of gender dynam-ics. A popular speaker and frequent guest onradio and television, Tear has trained thou-sands of men and women to recognize and usetheir natural differences to interact and com-municate more effectively. Tear's appearanceis sponsored by EWC-Business Women'sNetwork of the Allentown-Lehigh Valley

Chamber of Commerce.

Friday's program will also feature 15 work-shops. Participants will have the opportunityto choose from topics like: "Beauty Myths:Beware the Beasts"; "Enhancing PositiveValues and Self-Esteem in Children"; "Balanc-ing Intergenerational Needs: As Your Chil-dren and Your Parents Age"; "Sexual Harass-ment: Whose Fault is it, Really?"; "IllVIAIDS: Women at Risk"; "Life EvolvingChoices: What Our Mothers Didn't Tell Us";"Dual Career Couples: Balancing Work andFamily"; and many more.

The cost of the program is $35 for Thursdayor Friday alone, and $65 for both days ($60 forsenior adults, 55 or older, and students withidentification). Dinner is included on Thurs-day, breakfast and lunch on Friday. Scholar-ships will be available for selected collegestudents and women with economic need. Forthe latter, babysitting and transportation canbe included.

"For any woman who's thought about taking alittle time out just for herself, this is a greatway to do it," Shaw sums up. ''You can meetother women from all walks of life, get somequestions answered and learn some positiveskills. I think all of us will come away with asense of being uplifted."

The program can accommodate 44{) partici-pants Thursday and 320 Friday, and Shawrecommends registering promptly. For moreinformation or a registration form, call Wom-anCare at ext. ext. 3800.

Research Proposals DueThe Research Advisory Committee will meetto review clinical!epidemiological researchproposals submitted by the medical andprofessional staff of Lehigh Valley Hospital onFeb.23.

All proposals submitted by Feb. 5 will bereviewed at the Feb. 23 meeting. Furtherinformation and proposal guidelines may beobtained by contactingJames F. Reed ill,PhD, director, Research at ext. 8889.

PageS

Events Geriatrics Network Sets Organizational MeetingAn organizational meeting of the GeriatricsInterest Network will be held at 11:45 a.m.Thursday, Feb. 11 in Classroom 3, CedarCrest & 1-78.

Among the items on the agenda are a review ofaccomplishments, review of charter, settinggoals and objectives for 1993 and committeestructural issues.

Additional information is available from LisaLacko, RN, clinical nurse specialist, Geriatrics,and Mary DeHaven, director, Prestige Health.

Spring BazaarThe Recreation Committee will hold itsSpring Bazaar at Cedar Crest & 1-78 lobby onApril 1 and 2. Employees interested in partici-pating should contact Sharon Bartz at ext.8480. Space is on a first-come, first-serve basis.

Medigap Insurance CuverageA free presentation about changes in Medicaresupplemental insurance coverage, commonlyknown as Medigap insurance, will be held at 7p.m. on Tuesday, Jan. 26 in Classroom 1 atCedar Crest & 1-78. Sponsored by PrestigeHealth, the program features discussion ofMedicare Parts A andB and the differentMedigap plans by counselors from the Ameri-can Association of Retired Persons. To regis-ter, call ext. 7370.

Auxiliary Balloon SaleMembers of Lehigh Valley Hospital Auxiliarywill again offer those special Valentine's Dayballoons in a sale at the Cedar Crest & 1-78lobby on Feb. 12, 13 and 14.

Each helium-filled, transparent heart-shapedballoon contains a rose, creating an unusualValentine gift.

The sale is one of a number of fund-raisingactivities the auxiliary hosts that benefit thehospital.

Joining other activities is film processing at theTree Top Gift Shop, which began this week.

The auxiliary's premier event, May Daze, isbeing organized and will be held in its usuallocation in front of the hospital. Thoseinterested in volunteering to help may contactBarbara Showalter (821-8391), NormaCoffman (433-1932) or Elayne Hasik (435-4692).

HRD ActivitiesThe next hospital orientation will begin at 8a.m. at Cedar Crest & 1-78 auditorium on Feb.1 and an optional tour of both sites will be heldon Feb. 3 beginning at 1 p.m. at 17th & Chewand 2:30 p.m. at Cedar Crest & 1-78.

CPR recertification will be held in the 24 hourperiod beginning at 10 a.m. Wednesday, Jan.27 in the Nursing Learning Laboratory,General Services Building, Cedar Crest & 1-78.

CPR certification, for which pre-registration isrequired by calling ext. 2430, will be held intwo parts and attendance is required for bothBoth the March 4 and March 11 sessions willbe held in Room 900, School of Nursing, 17th& Chew.

Stress and Burnout - Care for the Caregiver,will be offered on Feb. 10 from 9 to 11:30 a.m.in School of Nursing Room 902. Call ext. 2430to register.

Coming in the Regional Symposium Series areUpdate in Dermatology on Feb. 11, UrologySymposium: CUTTent Concepts in the ManagementofBPH on Feb. 27; and the Fourth AnnualSymposium on Infectious Diseases on March 11.For additional infomi.ation and registration,contact Human Resource Development at ext.8322.

CheckUp is a biweekly employee publication ofLehigh Valley Hospital, Public Relations, 1243S.Cedar Crest Blvd., Allentown, PA 18103.Interoffice mail submissions should be addressedto 1243SCC-PR. For additional information, callext 3007.Lehigh Valley Hospital is an equal opportunityemployer. M/FIDN

Page6

Lean On Me Trimming Doum, Round 2: Hanging In ThereThe new year is just three weeks old, you'veresolved to shed a few pounds, and you wereone of many who called Health PromotionProgram to ask for free materials to getstarted.

Now there's a huge cheesecake staring you inthe face. It's courtesy of a co-worker, andeveryone is encouraged to share in the fattyfeast.

Maybe you had a real rough day on the job,and in spite of plans for a nice healthy salad,the lovely words "big gooey pizza" are rattlingin your mind.

Or perhaps you went to a birthday party lastnight and the eager host placed too muchtemptation under your nose. You dove rightin, ate too much, and today you're morose.Your diet has collapsed.

Not with this program. Rule number one isthat dieting (or "getting in shape," dependingon your gender) is supposed to be withoutstress.

If Y(JUfell off the wagon ...First of all, no one's perfect. Just because youoverdid it once doesn't mean you have to giveup. Climb right back on the wagon, take awalk, and pick up right where you left off.Don't promise yourself that you'll never dothat again. Keep the goals short term andrealistic. Promise that you won't do it againthis week.

Use your Healthy Dividends booklet to cut backa little further on total fat intake if it helpsmake you feel better. Next time, try a littleexercise before you go to the party. Thatshould boost your self-esteem and encouragerestraint. And, your goal for the next greatparty is to accept the fact that you're going tohave a good time and lighten up the fat intakea bit for several days beforehand.

If daily stress got toY(JU•••

Recognize it for what it is and look for otherways to unwind. If your hand hasn't gotten

into the sack of potato chips yet, assault anapple instead. The answer to your stress is notin excessive eating, it's in better mind manage-ment.

One real good way to relieve stress is physicalexercise, and even the non-aerobic kind can dothe trick. But if you refuse to let stress get toyour waistline, and go for a brisk walk instead,you'll find it's a lot easier to resist temptation.

For those who have a rough time with stress,Health Promotion Program will hold its free"Learn How to Relax" session onJan. 27 from7 to 8:30 p.m. It's open to everyone, andregistration is by calling 821-2150.

It's hard tojust say no ...A friend, co-worker or family member mayhave been well-meaning, but the treats are justloaded with the stuff that wrecks a weightmanagement effort. This is especially true

.during holiday periods. How many goodiestempted you between mid-November and Jan.2?

The answer is simple: be polite, take a smallserving, and be appreciative. You don't haveto show your appreciation by eating the entireplatter. If the provider is hurt by your declineof seconds, simply say you're watching yourweight.

Then there's the "friend" who gives you fivepounds of chocolates, which may be near anddear to your heart. Now it's your turn to be afriend. Enjoy a piece or two, then give the restof the box to your co-workers.

Finally, there are saboteurs, who for whateverreason are not about to let you get away withbecoming fit. This takes considerably morewill power, but you have to recognize theirmotives and just say no.

Making ProgressIt's possible that if you've been successful so farin establishing better eating habits and areasonable exercise effort that you might

Continued

Page 7

I

Lean OnMe,continued fromPage 7

I

Trimming Down, Round 2:Hanging In Therealready be noticing a looser fit in your cloth-ing, but not necessarily a loss in weight.

That's because exercise has been toning upmuscles, and muscles weigh more than the fatyou may have already lost. Peek if you want,but don't pay much attention to the scale.

On the other hand, you might be feeling moreenergetic, a consequence of good diet andexercise. Among the rewards of weightmanagement is more zip in your step and abetter attitude about yourself. Behaviorchange is more long term because of some-thing you are doing rather than something youare not doing.

Among the key things to do are to keeprealistic goals. Instead of saying "I ought tolose 10 pounds," say, "I plan to lose a pound aweek." If it hasn't been a good week, you cantry again.

On the long-term side, though, several thingsare going to happen. If you hold your fatintake down to recommended levels and getgood exercise, no matter how overweight youare, you stand a good chance of drifting downto a correct body weight for yoursel£ It'll startslow, pick up steam, then gently taper off asyou get close to proper weight.

More About ExerciseLast time, everyone was encouraged to take a"brisk" 20-minute walk. But what's "brisk" forsome might be a stroll to others. By now,everyone who asked for information has alsoreceived The Rockport Guide to Fitness Walkingto help you tailor a good pace for yourself.Anyone else who would like a free copy shouldcontact Health Promotion Program at 821-2150.

Also provided was information relating to justhow easy aerobic exercise can be. The purposeis to get heart rate up to a reasonable level andmaintain that level for a period of time. Thiscan vary with individuals, and, as usual, anyonewho suspects there might be medical concernsshould discuss it with a physician first.

Once you've set your pace at walking, yourbody will burn calories in the form of muscletissue blood glucose for the first 20 minutes orso, which is the prescribed length of the walk.To replace the lost storehouse, your body goeshunting for its fat reserves. Once past 20minutes, your body begins digging into bodyfat. While the exact rates vary a lot, theconcept is the same: you can lose weight with a20-minute walk, and you can lose even moreweight with a longer walk. Just keep the samepace.

There's an important long term side benefit toall of this. When you get regular, aerobicexercise, your body produces higher levels ofHDL cholesterol- the good guys - who doa fine job of clearing LDL cholesterol- thebad guys - out of your bloodstream. Thatimproves overall cardiac health and helpsreduce the risk of heart attacks. By reducingfat intake, you only help this important cause.

For the Next Two "WeeksContinue good dietary management byholding fat intake to proper levels. If you are aperson who snacks, bring your own carrot orcelery sticks and a tasty dip made from no-fatsour cream. Don't eat without thinking. (Ifyou work in a clinical area, remember that it'snow a violation of OSHA regulations to havefood wherever there may be exposure topatients or specimens; keep the treats in thelounge and away from temptation.)

Review The Rockport Guide to Fitness Walkingand tune up your walking program for maxi-mum effect with minimal effort. If you'recomfortable with a good pace for 20 minutes,you might want to add five or ten minutes tothe walk. But do take at least three 20-minutewalks each week.

Review stress levels. Under stress, you caneasily be eating too much. Exercise helpsreduce stress, but other programs, like "LearnHow to Relax" can help you manage better,and that can help you lose weight.

Page8