It is, by most accounts, the most industrious medical undertaking in the modern history of American hospitals. Just imagine an all-digital, paperless, physician-driven healthcare facility that features everything from patient “smart cards” to flat-screen televisions in every room … fully digital operating rooms (ORs) to Internet access and in-patient movies … integrated voice, data, video, and nurse call systems to a menu developed by the legendary Wolfgang Puck … and a fully automated laboratory with bar-coded samples to a concierge for patients and visitors.
Sound too good to be true? It isn’t. It’s a true-to-life healthcare story that’s unfolding before your very eyes in Southern California.
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| Although shown here (left) is a VIP suite, which means it’s bigger and has a 42-inch plasma screen monitor, comfort is still key at the Century City Doctors Hospital (right). All rooms feature a HiMed 15-inch flat screen from Siemens and a computer-access device, shown here at the foot of the bed. |
A new era in hospital healthcare arrived when Century City Doctors Hospital (CCDH of Century City, Calif) reopened its doors in October 2005. The original Century City Hospital closed its doors 2 years ago after the prior hospital’s corporate parent chose not to renew the building’s lease. Now, not only is the West Los Angeles facility back in business, but it could be the most digitally advanced hospital of its kind in America.
The Price of Luxury
At a cost of $100 million, the 178-bed hospital features advanced medical technology and an unparalleled blend of luxury, personal attention, and service. The soon-to-be-paperless facility includes state-of-the-art medical imaging and diagnostic equipment, comprehensive IT systems, and building-control technologies. Also, each of the hospital’s seven ORs is fully digital, allowing surgeons and physicians to exchange voice, data, and video sources with other resources both inside and outside the hospital.
Additionally, “smart cards” are issued to both patients and employees. For patients, the cards are used to ease preregistration, as demographic information on the cards enable a speedier registration upon the patients’ arrival at the hospital. For employees, the smart cards are used for badges; for physical access throughout the facility via a proximity reader; and for data-network access to IT systems, medical records, and the like. All physicians and nurses need to do is slide the cards into any workstation and enter a pass code and biometric (such as a fingerprint). Then, they can retrieve a patient record or adjust patient information.
CCDH CEO Joel Bergenfeld says the expenditure will be allocated in three areas:
- construction and renovation, $32 million;
- equipment, $55 million; and
- start-up costs, approximately $13 million.
Phase 1, which was completed in October, included completing seven ORs, patient floors, and an ICU unit; additional Phase 1 projects, including angiography, a GI lab, and inpatient and outpatient radiology and imaging, are expected to be completed this month. Also in the works is Phase 2, which involves adding another five ORs (bringing the total to 12) and renovating the hospital’s remaining two floors. This type of project usually comes with a strategic plan that is carried out “one product at a time” over a 10- to 12-year period,” Bergenfeld notes. “To roll it all out from the beginning, from scratch, is one heck of an undertaking.”
It certainly isn’t without its share of anticipated and unanticipated problems. “The hospital needed a significant amount of internal repairs and upgrades to code,” he explains. “In terms of bringing in an infrastructure for communications, information management, and state-of-the-art imaging, we had to put almost 500,000 feet of low-voltage cable throughout the entire hospital.
“The reality is that we’ve run into hundreds and hundreds of problems,” Bergenfeld continues. “And we’re trying to address them one at a time. Part of it is directly related to an understanding of what ‘paperless’ means. No one has done this [successfully]. Yes, some facilities claim to be all-digital hospitals, but they’re scanning in paper records. So they’re digital, but they’re using paper records to get there.”
A Little Help
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| The Century City Doctors Hospital employs the Pyxis supply dispenser. Qualified employees simply enter a pass code and the patient’s code; then, they remove the supply. It automatically sends a notice to the central supply department for restocking purposes and to the billing department. |
The vanguard of the renovated facility is its all-digital network designed and developed by Siemens Medical Solutions (Malvern, Pa), which also put its financial punch behind the project by underwriting $30 million of the cost.
Bergenfeld says that partnering with Siemens Medical made perfect sense on three levels: experience, financial backing, and the company’s understanding of the project’s enormity. “The depth and experience of the Siemens organization were keys for us,” he explains. “We have had experience working with Siemens in the imaging area, as well as the building and support areas. We also had a gut instinct, a good feeling initially in the company’s presentation and understanding about the depth of the project. Our feeling with going with one company and running most of it off of one platform was critical in the decision.”
He notes that Siemens Medical’s long-standing reputation in the medical community, coupled with its willingness to adjust to the day-to-day changes in any project of this magnitude, made it the obvious partnership choice. Of course, it didn’t hurt that Siemens was willing to “step up to the plate” with a start-up hospital and a start-up organization, and provide more than 30% of the total renovation cost.
“We think Siemens is a very large, well-capitalized company that will be around for the long haul, which is critical to us,” Bergenfeld says. “In this era, many times, smaller companies come and go.”
Klaus Dunst, director for healthcare in the Western Zone for Siemens One, maintains that joining forces with CCDH made perfect sense. “I felt that given the facility’s vision, it was a perfect fit for a partnership,” Dunst says. “We have been working throughout the United States with a number of hospitals, and CCDH filled our criteria. We also were very intrigued by the overall concept of a physician-driven hospital and liked the approach in particular.”
Siemens Medical has been with CCDH every step of the way. In fact, Bergenfeld admits that Siemens Medical was on the job a full 2 months before a contract was signed. “I can’t tell you how important it’s been having Siemens with us every day, because everything we do every single day runs off the Siemens backbone?starting with our billing system, to the switch on our phone systems, to our building-maintenance systems. Not only have we outsourced our entire IS [information systems] department to Siemens, but the company also is providing our entire IS department off-site.”
A Digital Dream
Going fully digital, Bergenfeld says, was the easy part. Eliminating the volumes of paperwork was another matter entirely.
“People are making better and better equipment, and it’s recording more and more data,” he relates. “So how do you take the data that’s in a critical care or an ICU?data that normally is entered by hand in a flow sheet?and, without paper, put it into a medical record? I think building the interconnect and getting the data transposed in a way that is useful, while eliminating the paper, is the hardest part. Many examples of digital experiments are available, but few examples, if any at all, are of a totally paperless environment.”
One of the most exciting by-products of an all-digital facility is that physicians will have immediate access to patient information. Andrew Deutsch, MD, co-director of CCDH’s radiology department, says the new network enables physicians to recall and transmit medical information at the touch of a button.
“We’re part of an outstanding group of radiologists who have the luxury of many subspecialty radiologists working for them,” Deutsch notes. “Now, they have the ability not only to perform their own reads and interpretations, but also to transmit that information remotely to home, to other offices for second or third opinions, or to collaborate with other physicians. The goal of converting to a digital environment is to be able to access the information well.”
Bergenfeld maintains that soon enough, other acute healthcare facilities will have no choice but to follow CCDH’s lead. “At the end of the day, all hospitals in the next five to ten years will be examining the need to become paperless,” he says. “The single biggest reason is that we are charged with the safety and care of our patients. It’s no secret that there are multiple errors in transcriptions of physicians’ orders, understanding physicians’ handwriting, lost orders, orders that are incomplete, or reactions to medications that aren’t properly recorded.
“The idea of having totally digital, totally paperless medical records is to eliminate those errors, to gain some sort of control on the patient’s side of the equation,” he continues. “When we started the hospital, we started on this basis from the get-go. Another reason to go totally paperless and digital is simply to expedite the amount of time the caretakers have to spend not only on documentation, but also on transmitting the order and expediting the care.”
Bergenfeld admits that CCDH was not modeled after an existing facility, because, quite frankly, nothing in America can match the totality of the healthcare center’s digital dreams. Other facilities, Bergenfield notes, are closely watching to see how CCDH handles the challenges of turning to an all-digital, all-paperless healthcare facility. A test case? You bet, the CEO admits.
“We have been contacted by hospitals all over the country. This has been a very difficult project to undertake,” he says. “Hospitals have many legacy systems. [To change over] is expensive right now. In the old days, this would have been considered a Medicare capital pass-through; today, you must be willing to assume the financial risks associated with a project of this magnitude. But I think we’re on the front end and the cutting edge, and other hospitals will follow as time passes. I think it will be sooner rather than later.”
Dave Cater is a contributing writer for Medical Imaging.
