Microsoft HealthCustomer Solution Case Study

Hospital Boosts Clinical Outcomes, Saves $1.4 Million, with Hospitalist Software

OverviewCountry or Region: United StatesIndustry: Health

Customer ProfileMemorial Health System operates Marietta Memorial Hospital, a 199-bed nonprofit hospital located in Marietta, Ohio.

Business SituationThe hospital wanted to boost patient care and hospital productivity by automating the process by which emergency department doctors transferred patients to hospitalists.

SolutionMarietta Memorial Hospital adopted the MD-LifeLine hospitalist solution from MedOne, built end-to-end using Microsoft technologies.

Benefits Saves US$1.4 million annually Reduces lengths of stay Promotes best practices, increases

reimbursements Boosts patient satisfaction Gains federal security certification

“Our hospitalists now spend more time on patient visits, thanks to our use of MedOne Systems and the Microsoft technology behind it. That just makes us better at providing superb care.”

Joanie Washburn, Vice President of Clinical and Support ServicesMarietta Memorial Hospital

Usually, higher quality comes at higher cost. But Marietta Memorial Hospital found a way to boost quality of care and clinical outcomes while actually reducing its direct variable costs by US$1.4 million. It achieved that seemingly paradoxical result when it decided to address inconsistencies and delays in the process that emergency department physicians used to transfer patient responsibility to the hospitalists in the inpatient unit. The hospital adopted MedOne Systems, a turnkey solution for hospitalist management and communication that is based end-to-end on Microsoft technologies. Using the solution, Marietta Memorial Hospital not only reduced that transfer time but also reduced the average length of stay and the 30-day readmission rate. Each hospitalist now saves 2.5 hours per day, enabling them to see their patients twice daily, instead of just once.

SituationThink about the costs in which the US healthcare system is mired, and you might think of multimillion-dollar medical technologies, or redundant tests ordered as prophylactics against lawsuits, or fee-for-service plans that spur higher medical bills.

You probably won’t think about the time it takes a patient to be moved from a hospital’s emergency department to one of its inpatient floors. But that was the cost driver on the mind of Joanie Washburn, Vice President of Clinical and Support Services at Marietta Memorial Hospital, a 199-bed nonprofit hospital serving communities in Ohio and West Virginia.

The hospital, like most others, maintained a staff of hospitalists: physicians, usually internists, who specialize in the care of hospitalized patients and who coordinate the provision of that care to assigned patients. Hospitalists generally entered the patient’s hospital experience as the emergency department physicians left it—but the handoff wasn’t always smooth.

Some hospitalists wanted to see patients in the emergency department before accepting them. Others traded calls and messages with the emergency staff for an hour or more until they could confirm their assignments. Some hospitalists were easy to locate; others weren’t. The inconsistent and highly manual procedures and flows of information continued throughout the patients’ stays, affecting, for example, the issuance and processing of medical orders.

These variables invariably lowered productivity and increased costs. They also stood in the way of Marietta Memorial

Hospital’s continuing mission to increase the quality of care and clinical outcomes. Everyone in the hospital—patients and professional staff alike—felt the weight of these issues. The patients’ primary care physicians were especially affected: they often received delayed notifications of their patients’ admissions and discharges and incomplete information during their stays in the hospital.

Washburn and her colleagues wanted to address these needs, but the solutions that they considered seemed to raise new concerns. A technology system might expedite and optimize the flow of information, but would that create security issues—issues that might disqualify the hospital’s electronic health record and meaningful use programs from meeting federal requirements?

SolutionWashburn and Marietta Memorial Hospital were not the only ones thinking about these issues. So was MedOne, a hospitalist service founded in 2000. Over time, MedOne had evolved from an outsourced provider of hospitalists to the provider of a turnkey solution to help hospitalists to maximize the value they deliver to their patients and their hospitals.

That solution is called MedOne Systems and is based end-to-end on Microsoft technologies, including Microsoft SQL Server 2008 R2 data management software, the Windows Server 2008 R2 operating system, Microsoft Lync 2010, the Windows 7 operating system, and Microsoft Office 2010. It was developed using Microsoft .NET Framework 4 and Microsoft Visual Studio 2010 Ultimate.

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“Microsoft technologies make for a highly effective, highly available solution, because we—and our hospital customers—avoid the incompatibilities that come with patchwork solutions from multiple vendors.”

Nick Nelson, Chief Operating OfficerMedOne

“We naturally gravitated to Microsoft technologies for several reasons,” says Nick Nelson, Chief Operating Officer at MedOne. “Microsoft technologies make for a highly effective, highly available solution, because we—and our hospital customers—avoid the incompatibilities that come with patchwork solutions from multiple vendors. Most hospitals already use some if not all of the Microsoft technologies in MedOne Systems, so it fits easily into their IT environments. We’re also using Microsoft to give our customers the most cost-effective solution possible, more cost-effective than Oracle, than Cisco, than Linux—which is only free until you want to do something with it.”

When Marietta Memorial Hospital executives saw MedOne Systems in action,

they knew what they wanted to do with it. The hospital has used the solution since July 2010.

The hospital first uses MedOne Systems when emergency staff is ready to transfer a patient to a hospitalist. The emergency room physician engages the solution through an interactive voice response system called “voice checkout”—Marietta Memorial is in the midst of deploying Lync 2010, which will take on this function—and transfers responsibility for the patient to the hospitalist staff. The solution bundles that information together with the patient’s health record since entering the hospital, identifies the most available and appropriate hospitalist, and delivers the file to that hospitalist wherever he or she is, through the hospitalist’s portable computer or mobile device.

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Figure 1. MD-LifeLine gives hospitalists a single site through which to send and receive messages, phone calls, and instant messages; and to track their patients and other assigned hospital patients.

The hospitalist interacts with MedOne Systems primarily through MD-LifeLine, a combination database and communications center on a portable computer (see Figure 1). MD-LifeLine includes all labs, vitals, studies, medication lists and administration records, medical history, family and social history, and a current assessment and plan—both for the hospitalist’s own patients as well as for Marietta Memorial’s other patients, any of which can be reassigned to the hospitalist as needed.

Hospitalists can view information about new patients awaiting admission and review their own voicemails and callback requests. The SQL Server database that supports MD-LifeLine works in connected or disconnected mode, syncing with the hospital’s system whenever a hospitalist reconnects with the network or the Internet. SQL Server—in part through failover clustering, virtualization, and database mirroring—provides the high availability that is an essential aspect of MD-LifeLine.

MedOne Systems also provides a way for other members of a patient’s medical team to reach the hospitalist or to leave messages if the hospitalist is unavailable. Hospitalists in turn can return these messages or initiate outgoing calls through the same portal software. Once Marietta Memorial Hospital fully deploys Lync 2010, the solution will use that Microsoft communications software from a tab within MD-LifeLine, giving hospitalists the ability to easily initiate instant messaging and hands-free phone calls.

BenefitsMarietta Memorial Hospital uses MedOne Systems to boost physician productivity, the quality of care, clinical outcomes, reimbursements, and the satisfaction of just about everyone involved in the healthcare process, from patient to professional.

Saves US$1.4 Million AnnuallyMarietta Memorial Hospital is solving its hospitalist productivity issues by using MedOne Systems. The previously inconsistent procedures that delayed the transfers of patient responsibility from emergency department physicians to hospitalists have been resolved using the streamlined and automated voice checkout procedure in MedOne Systems, which both speeds the process and makes it more accurate.

Better communication among all members of the medical team helps to get patients moved from the emergency department to inpatient beds two hours faster than before. With hospitalists receiving faster notification of newly admitted patients, they can visit those patients sooner. Hospitalists, specialists, nurses, pharmacists, and lab department technicians use their faster, fuller communication capability through MedOne Systems to issue, process, and confirm orders with greater accuracy and speed.

The productivity gains have a very practical effect. By saving time at virtually every step of a patient’s hospital stay, from admission to discharge, hospitalists are using the solution to save about 2.5 hours per day—a 25 percent productivity gain. Overall, the hospital saves $1.4 million in direct variable costs. The savings, however, does not show

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“Microsoft and MedOne play key roles in helping us to get our lengths of stay and readmission rates down and keep them down.”

Joanie Washburn, Vice President of Clinical and Support Services

Marietta Memorial Hospital

up on the bottom line: Marietta reinvests it in better patient care. Instead of each hospitalist visiting his or her 15 or so patients once daily, hospitalists now can visit each patient twice a day.

“Our hospitalists now spend more time on patient visits, thanks to our use of MedOne Systems and the Microsoft technology behind it,” says Washburn. “That just makes us better at providing superb care.”

Reduces Lengths of Stay, Readmission RatesWhen Washburn ties higher hospitalist productivity to better care, she has the numbers to back it up. Average lengths of stay, for example, have declined by .4 days, without any decline in clinical outcomes, meaning that patients get better faster. And once they get home, they’re more likely to stay there, too. Marietta Memorial Hospital data shows that the rate of readmission within a month of discharge—a key measure used by public and private medical insurance programs—has declined as well.

“Microsoft and MedOne play key roles in helping us to get our lengths of stay and readmission rates down and keep them down,” says Washburn. “For example, when our hospitalists first see their patients about three hours sooner than they did before we adopted MedOne Systems, that means the patients receive their diagnoses three hours faster, it starts their treatments three hours faster, and it gives them a three-hour jump on getting better.”

Promotes Best Practices, Increases Reimbursements

The standardization of the patient handoff process through MD-LifeLine leads the hospitalists to follow established best practices that combine effectiveness with efficiency.

“We use templates in MD-LifeLine to ensure that our entire hospitalist staff follows proven techniques and protocols for effective care,” says Washburn. “That benefits the patients while it wrings excess costs from the system.”

Hospitalists also use the software to enter treatment and billing codes into electronic patient files throughout the day as they go from patient to patient, rather than waiting until the end of the day—or later—to enter codes for batched groups of patients. The difference contributes to greater accuracy and more complete coding, because treatment codes are less likely to be overlooked or entered by mistake. Optimal coding enables Marietta Memorial Hospital to gain all the reimbursement to which it is entitled from Medicare, Medicaid, or private insurance.

Boosts Satisfaction Among Patients, Hospitalists, Primary Care PhysiciansPatients, hospitalists, specialists, and primary care physicians—everyone is more satisfied with the new solution, according to Washburn.

“We’re using Microsoft and MedOne technology to deliver better, faster patient information to the hospitalists, which means they can share that information with patients and their families more quickly,” she says. “Patients and families appreciate the increased communication. People comment to me—much more than before

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“We’re using Microsoft and MedOne technology to deliver better, faster patient information to the hospitalists, which means they can share that information with patients and their families more quickly.”

Joanie Washburn, Vice President of Clinical and Support Services

Marietta Memorial Hospital

—about how their doctors took the time to explain issues thoroughly and to be helpful. Hospitalists can do more of that now because we use MD-LifeLine to free their time for exactly that type of physician-patient interaction.”

Washburn expects the higher quality of patient care—and increased patient satisfaction with that care—to help the hospital to meet the requirements of the federal government’s Value-Based Purchasing Program, under which hospitals are rewarded for the quality of their care, rather than for the volume of services they provide.

Meanwhile, hospitalists are more satisfied because so many of the processes they had to conduct manually are now streamlined or handled automatically by the software—such as the call-in procedures formerly required for them to obtain lists and descriptions of their patients. Hospitalists also cite the ability to gain up-to-date patient information at any time of day. Washburn expects that once Lync 2010 is fully deployed, and hospitalists and other staff can reach each other through one-click instant messaging or hands-free phone calls, staff satisfaction will increase further.

“Already, our emergency department physicians are very happy with voice checkout,” says Washburn. “And they were a driving factor for us to first reach out to MedOne.”

Primary care physicians, who typically have little information about their patients’ admissions, treatments, and discharges, express perhaps the greatest satisfaction

with the changes that come with the Microsoft and MedOne technology.

“The automated notifications that primary care physicians get when their patients enter and leave the hospital, and the up-to-date treatment information they can get simply by speaking a patient’s name into an automated phone line is huge—really huge,” says Washburn. “I hear about it from primary care physicians repeatedly. Now they know exactly what discharge instructions their patients received and when they’re likely to see them in their offices. That better communication is another contributor to the lower readmission rates we’re seeing.”

Sometimes, satisfaction with the solution comes from unexpected sources. “We’ve even seen the Microsoft and MedOne technology beneficial in recruiting great doctors,” says Washburn. “When we show this system to physicians we’re recruiting, it impresses them. One prominent pulmonologist joined our staff in part because of the comfort level that he had with the care that our hospitalists would give to his patients, based on having MedOne.”Gains Federal Security CertificationPerhaps few industries are as regulated as healthcare—which makes it crucial that the Microsoft and MedOne technologies in MD-LifeLine should meet relevant federal requirements. They do. Washburn says that MD-LifeLine is crucial to the hospital’s meeting phase one of federal meaningful-use requirements—and will be crucial again for meeting the upcoming second phase of those federal regulations. The solution is federally certified for electronic health record systems and meaningful use by the

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“One prominent pulmonologist joined our staff in part because of the comfort level that he had with the care that our hospitalists would give to his patients, based on having MedOne.”

Joanie Washburn, Vice President of Clinical and Support Services

Marietta Memorial Hospital

Certification Commission for Health Information Technology.

“We just finished our security audit for meaningful use,” says Washburn. “One of the biggest potential sources for HIPAA [Health Insurance Portability and Accountability Act] breaches is lost personal devices, such as portable computers. But our devices use Microsoft encryption and, if they’re lost, we can erase the hard disks with Windows security features. I don’t have security concerns about this system.”

Microsoft HealthMicrosoft technology can help healthcare practitioners and insurance providers in giving patients the best medical care and coverage possible.

For more information about Microsoft Health please go to:

www.microsoft.com/industry/healthcarewww.microsoft.com/industry/healthcare/providerswww.microsoft.com/industry/government/healthwww.microsoft.com/industry/healthcare/healthplans

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For More InformationFor more information about Microsoft products and services, call the Microsoft Sales Information Center at (800) 426-9400. In Canada, call the Microsoft Canada Information Centre at (877) 568-2495. Customers in the United States and Canada who are deaf or hard-of-hearing can reach Microsoft text telephone (TTY/TDD) services at (800) 892-5234. Outside the 50 United States and Canada, please contact your local Microsoft subsidiary. To access information using the World Wide Web, go to:www.microsoft.com

For more information about MedOne Systems products and services, visit the website at: www.medonehp.com

For more information about Marietta Memorial Hospital, visit the website at: www.mmhospital.org

This case study is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY.

Document published May 2012

Software and Services Microsoft Server Product Portfolio− Windows Server 2008 R2 Enterprise− Microsoft Lync Server 2010− Microsoft SQL Server 2008 R2

Enterprise Microsoft Lync 2010 Microsoft Office 2010 Microsoft Visual Studio− Microsoft Visual Studio 2010

Ultimate

Windows 7 Technology− Microsoft .NET Framework 4

Hardware Dell Latitude E4300 and E4310 laptops

Partner MedOne Systems