Fierce Q&A: Ben Kanter, Orlando Portale on Palomar's IT makeover

Earlier this month, Palomar Health opened its new 288-bed facility, Palomar Medical Center in Escondido, Calif. The facility, which cost $956 million to build, has been dubbed the "hospital of the future" for its use of state-of-the-art technology to connect patients and providers.

Palomar's Chief Medical Information Officer Ben Kanter and Chief Innovation Officer Orlando Portale recently spoke to FierceHealthIT about their expectations for the hospital today--and what health IT will look like a decade into the future.

FierceHealthIT: How do you expect the new hospital to impact care, day-to-day, from a technological standpoint?

Ben Kanter: The new hospital is not meant to be a replacement for our current facility, nor was it meant to reflect a hospital as most people expect to find them in the community today. We knew that technology was changing rapidly, and so this building had to be flexible. None of us are smart enough to anticipate where technology is going to be five to 10 years from now, and you don't want to build a $950 million building and have it be antiquated within the first few years.

The second piece is is that we re-imagined the way care is being delivered based on best practices, evidence-based healthcare design and other principles. So as you walk into our facility, you no longer see centralized nursing stations. The nurses have been moved out to the patients bedsides for distributed nursing.

We also wanted to improve where current hospitals have problems. Current hospitals have difficulty really allowing the nurse and the patient to communicate efficiently and quickly, and we wanted to use technology to help us there. We also wanted to be able to track our patients and their vital signs and alarms, and put that more in the hands of the bedside nurse, rather than a unit secretary or someplace else.

FHIT: Can you give me an example of how you plan to improve communications between providers (doctors and nurses)?

Kanter: We knew that we wanted to put the nurse, in particular, physically closer to the patient, but we also wanted to allow the patient to communicate with the nurse or the physician in a much easier manner. At typical, older hospitals today, a patient rings a call bell, it goes out to a centralized call station where there's a unit secretary who gets that message. That's the message for water, the message for pain, the message for dizziness; they then have to find the right person. That person then has to walk over to the room, and it's a difficult chain of communication with a lot of potential for error.

Now, the nurses are all carrying web phones that are integrated with the call system that the patients have. We're also using a middleware so that we can now intelligently route patients' call to the nurse or the nurse's aide. In our hospital today, if the patient has pain, they push a button that puts them in direct, one-on-one communication with the nurse, immediately. If they need water, that doesn't bother the nurse because the nurse is busy doing other more high-level operations … that would go directly to the nurse's aide.

We've made efficiencies there by taking people out of the loop that didn't need to be there, and trying to fit the patient and the nurse into that collaboration. Also, with the nurses having smartphones, I, the physician, can directly call the nurse from outside the hospital. Before, I would have to call the floor; the floor clerk would then have to find out where the nurse was and put me in contact with the nurse.

FHIT: Can you talk about security at your hospital? What are you doing to keep patients and staff members safe from an IT perspective?

Kanter: We have two networks at our hospital at a high level: one is what we're using for patients and patient care and the other is a public desk network. So if family members want to use devices, or physicians want to use devices, they come in, as a physician for example, through our outside desk network, the same way they would come in from their home or office using the same security protocols that exist nationally for electronic health records.

Orlando Portale: We've applied generally accepted principles and best practices across the IT industry for locking down our network and all of the IT assets.

We're also the first hospital in the U.S. to use next generation iris scanning technology at all points of registration. So when the patient presents at a registration desk, we take a snapshot of their eyeball, and are able to match that image against a database that we maintain. We're able to do a very efficient match so that we're properly identifying patients when they come in and that all of the medical record information is properly maintained under a single patient identifier that's tied to that biometric ID that's based on the imprint of the vascular infrastructure of their eyeball.

Kanter: The technology's not just cool; we really do not like to use technology just to use technology. We have a real and serious problem with patients being registered and presenting with different names for the same hospital. Someone will come in, for example as Francis G. Adams one visit, then F. Gerald Adams; they may go by Gerry Adams. It can be very difficult, and if we don't have access to the right records at the right time, first of all it's very inefficient, and secondly, we could actually hurt somebody. 

FHIT: Tell me a little more about the flexibility you mentioned earlier.

Kanter: We're not looking one or two or three years down the line; we're looking at what kind of technology might we need, might be ubiquitous, 10 years from now, 15 years from now. What if every patient eventually expects to have video in their room? What if we're moving enormously large complex datasets from place to place? What about as we complete the build out of our remote clinics, we need to do telepresent healthcare? What if there's more robotics? What about new types of scanners and monitors for patients? We're really trying to make sure that whatever comes down the line, we're not going to have to go in and pull cable five years from now.

FHIT: Do you guys see yourselves as trailblazer in terms of hospital development?

Portale: As the innovation officer, as you may know, there are maybe at best you can count on one hand the number of hospitals in the U.S. that have an innovation officer proactively investing in next generation solutions like what we've been talking about. I would say if you stack us up against really most hospitals across the U.S., we are really at the forefront in terms of our ability to experiment, to collaborate with industry, to do our own research and design to push things forward. We really want to set an example for the industry about what's possible. That's reflected in this new building.

Editor's note: This interview was edited for length and for clarity.

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