UCSD CIO: Health IT won't work unless providers understand its value

The University of California San Diego Health System (UCSD) recently received a rare honor: HIMSS Analytics gave UCSD a Stage 7 award, which means that it has reached the highest level of advancement in electronic health records. 

Only 60 hospitals and health systems in the U.S. have achieved this recognition, and no wonder: to do so, an organization must have a complete EHR system, including computerized physician order entry, physician and nursing documentation, closed loop medication administration, clinical decision support, ancillary systems, a data warehouse, and the ability to exchange information with other healthcare systems.

Edward Babakanian, chief information officer of UCSD, says he feels honored that his institution received the Stage 7 award. The key to getting this far, he tells FierceHealthIT, was his organization's realization, about 10 years ago, that the purpose of information technology was to improve patient care. Without that vision, he says, it would have been difficult to get the traction required to make so many changes.

"Often, technology disrupts people's lives," he notes. "The best thing to do is get them involved in the process so they know why they should do that--in other words, what's the value?"

Babakanian has been at UCSD for 16 years. Originally, he was CIO at the university medical center; now, he reigns over IT for the entire healthcare system, including its hospitals, ambulatory care clinics, and research and education components.

When Babakanian started working at UCSD, the organization was using a legacy information system that was old and slow but that it was contractually locked into. He says he scored his first big success by making a few programming changes that converted that system into something that helped clinicians do their work more efficiently. His team replaced the software's green screens with a graphical user interface; ensured that the system was available 24/7; and installed a file cache that greatly improved system performance, so physicians could call up lab results almost instantly.

That was only the beginning. When UCSD decided to implement CPOE, Babakanian explained to both pharmacists and physicians that it could improve the chances that the medications that the doctors ordered would be the ones delivered to patients. With the help of a friendly OB/GYN, he also talked the reproductive medicine department chairman into having his department be the guinea pig for CPOE.

Before the three-month pilot was over, the OB/GYNs decided they wanted to keep using CPOE, and made suggestions to improve it. In the meantime, Babakanian's friend had become chair of the hospital's medical executive committee, and helped him convert the rest of the staff to CPOE.

At that point, UCSD's main IT vendor agreed to integrate CPOE with its pharmacy system, to which UCSD converted. "It took years for us to get these systems to talk to each other," Babakanian recalls. "But now, when an order is placed through a protocol, it electronically gets transferred over to pharmacy, pops up on the pharmacist's screen, and they can do what they need to do. A process that would have taken two or three hours of service time to get a medication delivered to a patient now takes two or three minutes."

Next up was the electronic medication administration record (EMAR). This was a challenge because the bulk of medications weren't bar-coded. Babakanian's team had to negotiate with drug suppliers to bar code at least 75 percent of their units, and then the pharmacy department had to be persuaded to do the rest. "They said, 'We'll need 50 people to do it,' but in the end, they did it with no additional people."

"That whole process created a perception of value among care providers," Babakanian says. "Because they said, 'I can put an order in, and I can be sure that no one will make a mistake when the nurse is giving that medication. And I know it's exactly what I ordered.' So we improved quality and efficiency and reduced the workload for nurses, because they were able to eliminate their paper MARs--that's a huge time saving for nurses."

Having done all of that with software that was several decades old, Babakanian convinced the administration that it was time to switch to a more capable IT system. Six years ago, UCSD started implementing Epic in its ambulatory-care clinics, and a few years ago, it replaced its legacy hospital system with Epic, as well. Today, the only systems that are non-Epic are the ones used in the ED, radiology, lab and cardiology departments, and all of those systems are fully integrated with Epic.

Babakanian doesn't believe that Epic or any other vendor can provide a total solution, especially in an academic medical center environment. For example, he notes, the lab system that UCSD uses is "uniquely qualified to do things like blood bank and anatomical pathology and support transplants and genomic research. Epic can't do that. It's got a basic lab system that works in a basic environment. But in an academic environment, where we do genome sequencing and so on, we need a more sophisticated system."

The important thing, he says, is that the interfaces with the enterprise system be seamless, so that demographic data can flow to the ancillary applications, and the latter can feed relevant information back to the clinical care providers.

Babakanian believes that awards such as those from HIMSS Analytics serve a useful purpose by encouraging healthcare organizations to set their sights high. "Fundamentally, though, organizations need to believe that technology can add value to patient care. And those who do will be successful. Those who don't will give up after a while and say, 'This is not for us.' Only that's not the case."

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