Strategic Projects

Middletown Regional Hospital, Middletown, Ohio: Initial needs assessment, program and $15M technology budget development for all special systems in campus planning project of clinical, administration and radiology departments, including information technology and building controls integration, for this  $140M, replacement of the current 280 bed facility. Assessments included all assorted IT data-voice-AV-TV and training systems and also the building automation, controls, telemetry nurse call and other CE, supported systems, and OR telemedicine and remote surgical support provision planning.  A stand alone PACS and RIS study and related informatics RFP was developed with an approximate budget of $5 M

 Our study purpose was help the Hospital choose what it wanted to have eventually by:

• Understanding its needs, how future technology would support business and clinical goals and what the team would like to build as “ideal” if resources were not a challenge;

• Given this “ideal” state, but facing economic realities, devise a modular, scaleable, phased plan for technology additions, to attain the desired future “ideal” state over time.

• The plan context also needed to allow for the need to change with medical markets, with ability to nimbly adapt, and flexibility to consider, justify and add to systems and integrate new innovations.

Findings of Importance:

 Initial assessments results included creating and gaining approvals of new “ideal state” IT integration models that combined or migrated over time integration of building, clinical and IT systems to attain long term hospital goals.

 Wireless nurse communications for both inside and outside the facility, including the hands-free nurse to doctor and nurse to nurse communications systems recommended, saved more than 20 minutes per-nurse per shift and allowed immediate and time saving staff to staff communications. These findings were later validated in parallel efforts at Mayo Rochester and in Kaiser Health Care System in California.   

•  Facilities management felt the study really prepared it to “go shopping” and where best choices and the hard questions lay.  Suppliers wee pared down to three leading “best of breed” Building Integration Systems. Firms were formally and carefully compared, with input and feedback during the process from facilities management, as to their features, functionalities and benefits.  Systems were also considered from “a best practices” and integration standpoint using interviews of main customer sites and third tier technical support of these firms.

•  Cost avoidance strategies consolidating facilities and IT infrastructures and very robust wireless platform options appeared to save over $500,000 and delivered superior performance and coverage.  Fail safe communications infrastructures delivered a four fold increase in band width at less than a 20% increase in cost

•  The separate final budget of just under $5M was created for PACs and RIS. The figures were gracefully reduced initially by about $1M while delivering enhanced performance, a more reliable site and identified implementation options. Department confidence increased and it s confidence grew that its choices were balanced, well made and numbers correct. 

• Needs assessments, staff training plans, upgrade and integration planning was also done with the PACs RFP written for owner selection and implementation. 

• Disaster recovery and business continuance recommendations included on site and off site alternate control center back ups in conjunction with the security consultant and total costs budgets considered with the facilities group.

• Project technology cost estimates and implementation sequencing were delivered.  

Similar types of project planning were also included work with UC Davis Medical Center in Sacramento, and Advocate Health Care Systems, Chicago.

            References:           Karen Frank; Project Manager                904-308-8552

                              John McKinney; Facilities Manager:      513-705-0614   

University of California Davis Medical Center, Sacramento, California:   This design project focused on owner goals of optimizing the profitability of in house and remote radiology department revenues, finding productivity gains for this high profit department and future proofing this purpose built facility.

We supported the usual assortment of  IT data-voice, AV-CATV and CE supported systems and came into the project at mid-design development (DD), with support through CSI formatted Construction Documents (CD) and Selection Phases.

Of Importance:

• Need to do A&E “schedule rescue” good will restoration and to catch up from being six months plus behind to being “on time.”  (Did so)

• This was an Important Project to the Architectural team because of future other “University of California” Medical Center potential business.

•  UCDMC pioneering work in pre-standards luminary site Picture Achieve Communications Systems (PACs), the challenges of this networking design and totally new requirements to specify. (The final Spec we supported was 960 pages)  

• Need for “Future Proofing” with “Blown Fiber”, “RADIAX” wireless, “smart” foundations and other and innovative options.  What was done differently and worked that this client liked, was the unit pricing format and illustrations used that allowed Departmental decision makers to feel in control and select work station hardware with knowledge of first costs.  A model, mock ups and pictures also supported streamlined the client decisions.

•  Attained Saving of $225,000 on cabling supporting the code case for our EE and our PM.

•  Level 4 Seismic design with approval gained required of the first submission to State approvals and processes for the Office of Healthcare Statewide Planning (OSHPD).

•  Helped improve A&E to client relationships, better supported the University Project Manager and cooperated in “winning the right battles” together.

•  Change of owner orientation to Best Value rather than First Cost

 References: David Marshal PE (formerly HGA Electrical PE of Record) (on request)

Also Richard Kennedy, UCDMC Radiology Department; currently Director of Informatics and PACS, Kaiser Permanente (number by request)

Northwestern Memorial Hospital, Chicago, Illinois:  Technical design team consulting on a variety of future trends and network technical issues on the worlds largest hospital project of over 2 Million SF.  This major $560M redevelopment project was supported in several ways by special projects works, which are highlighted. Although each project has a detailed story, only Nurse Call is elaborated upon to give a sense of the level of depth and excellence this project team had.

Of Importance

 1)         Nurse Call Inception Study:   The study was a “first of type” and novel due to its client focus and coverage of all viable US offerings. The discovery process with 7 key NMH staff ascertained critical functional systems integration and clinical requirements for these systems as well as owner buying criteria to streamline both selection process and to assure proper technical choice would be made.

• Clinical and staff time saved when staff was over taxed with other project issues was the main benefit of this effort.

• Besides time saved, the clinical team was prepared to see demonstrations and ask good questions due to this effort.

•  Because standards of comparison were accomplished, the project team saved time and the selection more resembled a pricing exercise than a formal bid.   

 Methods:      

Best practices at the top 10 hospitals in the nation including Mayo, Cleveland Clinic and Johns Hopkins in nurse call related issues were assessed by interview.  32 different vendors were assessed and sifted with 8 different strategic areas proposed by staff, with buying criteria cutting this to 5 viable choices.  Technology direction, costs and overall value assessment were rated in the final report format and considered the top 3 clear choices.

 This study:

•  Streamlined process, freed the clinical staff from this very time absorbing task allowed the staff to focus on other high multiple priorities (which were also far behind schedule on) to help get the project team back on time.

• . Eliminated many of the vendor created political problems usually associated with nurse call system selection processes.

• Cut electrical infrastructure construction costs by 11% by debunking and quantifying unfavorable options.

•  Using the staff selection criteria developed by the consulting and clinical team, delivered gave the clinical team its choices, operational differences and reasons, pro and con for each choice. 

 2) Quality reviews of communications and data technical infrastructures of nearly 100 communications closets and over 5000 communications outlets on the new hospital construction and data network design documents and specifications.  Radio and related device paging device antennae placements were also considered.

 3) Problem solving of an architectural error that would not allow radio frequencies into the building due to glass pigmentation.  The problem was mitigated and an opportunity to give patients and families more freedom of movement with active wireless patient vital sign monitoring was created.  Design involved 35 vertical radio antennas in regular spacing to accomplish both radio device coverage (police, fire, PCS, Cellular, pagers, etc.) but is used to get people out of bed and moving toward recovery sooner.  

• Eight other owner special studies or technical support in areas including:

• RF Paging System Modifications and coverage re-design;

• Technical support of owner selection of high speed shared and radiology networks;

• Integration issues of Clinical Engineering and Building Systems Integration;

• Cable Management Software;

• Support of owner cost effective structured wiring design;

• Pneumatic fiber optic versus standard fiber optic for back bone use;

• Technology, pricing and practical considerations of PBX versus Centrex for the facility;

Cooperative task orders work with the owners other consultants Ernst and Young and First Consultants, and others...    

Reference:       Paul Barry, Ex. Director of Communications and Networks NMH, and Currently Vice President Information Technology Borg Warner

Christiana Durovich, Former Project Manager,  NMH Redevelopment Project; Currently Director of Facilities, Baylor Medical, Houston, TX.      

Joseph Dysko Former Director of Clinical Engineering Northwestern and

The Advocate Health Care Systems, Mercy Heath Care System (Contact Numbers on Request)

Johns Hopkins Medical System Management consulting to the office of the Dean and CEO over the combined entities of Hopkins including the Health Care System, School of Medicine, Johns Hopkins University, Johns Hopkins Singapore and the Advanced Physics Lab. in various domestic and off shore diversification, acquisition, telemedicine and outsourcing projects.

Of Importance:

Origination of outsourcing discussions and feasibility study support and board action on outsourcing 7,000 Hopkins staff to a newly created organization in support of the acquiring company's COO and CFO in cooperation with Hopkins President, CFO, COO and CLO and their select board members

• Strategic planning and technical feasibility design and business case support of off shore national heath care plan for wireless kiosk prescriptive and medical information systems in support of the Office of Special Projects for the government of Australia

• Business case and technical feasibility support alternate secure communication network for control substance pharmaceutical distribution system for India.

• Initial assessments of probable costs, likely suppliers and high level implementation time frames with the Departmental leadership of Johns Hopkins and its radiology staff of the feasibility of implementing digital radiology using PACs technology to save facility space and evolve towards computerized digital patient records

 Initial wireless systems assessments and high-level recommendations    

Projects under Home Land Security “need to know” or NDA basis are not discussed.

References:  Cary Kriz, formerly Office of Dean and CEO; Manager Special Projects; now CEO of an Informatics firm:  Contact Information by request.

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