Tim Armstrong was golfing with a friend when the conversation turned to a job opening. Armstrong, who had retired from a career in the auto industry after serving in numerous senior executive positions, took an interest when he heard the chief information officer position at Brant Community Healthcare System (BCHS), one of Canada’s preeminent community healthcare organizations, was vacant.
And although Armstrong had never worked in healthcare before, he found retirement to be less exciting than he had hoped and jumped at the chance to reenter the workforce. When he started with BCHS, he was stunned.
“Currently, most of the physician documentation is handwritten or dictated on notes. We’re trying to get them to use mobile devices as they round the patients.”
“I was shocked at how far behind healthcare is with technology when I compared it to where industry has gotten to in the last twenty years,” he says. “My first week, we were down for four days because one of the servers failed.” BCHS physical servers employed a “die and fry” strategy in which IT waited until the device failed before replacing it.
Even if the company replaced a broken device, Armstrong says, it would swap the device with a similar model and not move forward with new technology.
That was only five years ago. Since then, Armstrong has helped BCHS completely transform its technology to become more data-based, which has therefore improved patient care.
“The company received a report from a consultant four years before I got here, telling them it needed $4–8 million to refurbish its server environment,” Armstrong says. “When I looked at the ongoing cost of maintenance, which was in excess of $300,000 a year for the infrastructure, I quickly understood there was a chance we could go on a lease program and finance it all through a five-year lease. That’s what we’ve done and at a cost that’s a little bit less than what it was costing us to repair on an ongoing basis.”
At the time, Armstrong decided to modernize the infrastructure of the hospital by virtualizing its systems and converting the Unix environment to a Windows one.
Over the course of his time with the organization, Armstrong has completely redone its entire infrastructure and has achieved zero downtime. In the three years before he signed on, the average downtime per year was from eighteen to twenty-five days.
Armstrong uses the hospital’s printer implementation as an example. “We have implemented a standard printer strategy across the organization,” he says. “We now have the capability to redirect print jobs to other printers instead of stopping patient care. It’s a simple concept, but we used to have a mishmash of customized printers, and if one was down, there would be downtime.”
A Leaner Machine
Armstrong is also changing BCHS by adding business intelligence tools to BCHS’s platform that will help drive lean improvements.
“Our Meditech environment, for example, still uses technology that was designed back in the seventies,” he says. “We’ve been successful in putting in some technology to convert it from a proprietary database into a SQL database.” This move allows the organization to conduct deeper, more useful analytics.
By doing this, Armstrong has made way for BCHS to move forward.
Another major focus of change is in its emergency room. Along with Dr. Eric Irvine, chief of the emergency department (ED), Armstrong is implementing data measures to improve wait time and allow more patients to be seen.
“Our ED chief of staff had some beliefs that we couldn’t improve emergency performance, so we mitigated the number of outpatients in emergency and improved the emergency area dramatically without adding any physician resources,” he says. “We used to see about 100 patients a day, and now we see about 160. And most of our metrics have improved significantly. The average time-to-physician initial assessment has improved, and all of our length-of-stay metrics have improved.”
Sharing Is Caring
BCHS, in partnership with enterprise business-intelligence software company Information Builders, is leading the launch of an app exchange in which it will be able to share projects with different hospitals in Ontario. By doing so, it will allow them to work collaboratively to improve overall systems and processes.
“Because we’re publicly funded, there’s no competition between hospitals, and as we build out business-intelligence applications through Information Builders’ technology, we can upload these components to an app exchange,” Armstrong says. “As long as you’re a member, you can go to this website, and download components, and customize it to your look and feel within your business-intelligence tool right on your desktop.”
The sharing was then taken a step further with planned, coordinated projects between hospitals.
“If you look at our project lists, we’re all doing similar projects,” Armstrong says. “So, for example, instead of having each of us do an emergency room scorecard, you would select one of the hospitals to do that one and another to do an acute scorecard. We would swap the work between the two of us and get two projects done at the same time.” One such project has been dubbed an “antimicrobial stewardship.” For this project, all the linked hospitals are putting tools into the app exchange so they can have quicker adoption.
Before He Goes
Armstrong feels that he has another few years left in him before he tries retirement again—and he has more plans for improving BCHS before his work is done. One of the things he would like to accomplish is helping physicians get more into a twenty-first century mind-set.
“We’re working toward increasing our end analytics score, and the tool we’re working on is related to physicians and getting them put up on an electronic system,” he says. “Currently, most of the physician documentation is handwritten or dictated on notes. We’re trying to get them to use physician order entry, physician documentation, and physician desktop so they can have mobile devices as they round the patients.”