Healthcare systems and data equipment perpetually have to adapt to changes caused by fluctuations in the industry. Clinical systems informatics integration (CSII) is one way to better enable access to clinical records and databases. High costs, shorter hospital stays, and a reduction in hospital staff have demanded new ways to pass information to those who need it most. When data from various sources are successfully integrated and accessible, the overall quality of patient care is improved, and lower costs are achieved through time savings and easily accessible resources
Civista Medical Center, La Plata, Maryland

Using one of Gilbane's recently completed projects at Civista Medical Center in La Plata, Maryland, as a case study, this article examines how construction managers and architects can deliver the most value to healthcare clients by helping them develop specialized clinical informatics solutions.

The scope of the work at Civista included implementing a wireless network to aid in point-of-care clinical documentation; implementing an integrated electronic medical record, including document imaging for paper records, online clinical documentation, bedside medication verification, and physician-order–management software; and establishing remote access to the electronic medical record (EMR) for physicians.

The second phase of the hospital's construction project encompassed a network replacement, the extension of the wireless network, the addition of wireless voice-over-IP telephones, and the integration of the nurse call system to the wireless phones at the point of care.

Laying the Groundwork

Many times owners have goals they want to accomplish, but they may not see how to integrate their systems to achieve those goals. In the case of Civista, we facilitated the complex process of configuring their systems to communicate with one another by starting with the right information. One of most important questions we asked up front was what the owner wanted included for information technology. Sometimes owners procrastinate about deciding which IT systems to include because of the initial expense, but this can result in costly change orders later.

CSII basically means getting all of the hospital's clinical equipment—such as physiologic monitors, IV pumps, ventilators, anesthesia machines, the nurse call system, Pyxis or Omnicell automated medication-management cabinets, and even beds—to communicate with its house IT systems and, ultimately, to the EMR.

At Civista, we began by assembling a multidisciplinary integration team. CSII requires objective support from all levels, and joint development is crucial. We conducted a brainstorming session to identify all of the hospital's systems and, from that list, we determined which ones would need to talk to one another.

Drawing from the team's knowledge of the hospital and using our own project engineers, we were able to get everyone contributing at the necessary technical level about these systems early enough to maximize system capabilities, purchase effectively, and avoid rework in the field.

What CSII Means for the Client

CSII involves the integration of financial, clinical, and patient care systems to facilitate easy access to data. A number of factors drive the need for integrated healthcare data, including:

  • Decentralization of care

  • Cost controlling, quality improvement, and business imperatives

  • Healthcare data reporting and federal reporting regulations

  • Operational efficiency and patient satisfaction

When all clinical systems integrate and are fully functional, the organization can meet its management goals of patient safety and operational efficiency. One specific benefit is adherence to the JCAHO regulation that requires healthcare organizations to establish verification of clinical alarm operation.

At Civista, the integration of the hospital's clinical systems has allowed more time for patient care and has increased communication between physicians and nurses. When the correct systems are online together and feeding information to the correct sources, it helps staff members get more work done with fewer people and improves efficiency.

One of the biggest factors increasing the need for CSII is the move toward the EMR. No other clinical computing topic is getting more attention than this initiative. Implementing an EMR system is inherently a systems integration task; it goes without saying that the information needs to come from existing data sources within the hospital. As part of Civista's effort to get physicians better connected and to increase operational efficiencies, the hospital plans to automate all of the pieces of information that go into a patient's record.

Creating a Process Flow

The process for CSII ultimately stems from the answers to various questions asked early in the project. We asked Civista's project team how the IT system would be configured—hardwired or wireless—and whether it would require additonal space. Other important questions include:

  • Is there a schedule for the selection and procurement of all the clinical equipment and systems for the project? Who will manage the process?

  • Does the hospital organization participate in a buying program or have a strategic supply alliance with any major vendor for the required equipment and systems?

  • What are the communications systems that will be incorporated into the project? What are the security systems?

  • Does the project include headwalls or headwall columns?

  • Will physiologic monitoring systems operate with telemetry? Will there be one central monitoring system?

  • Does the project include the implementation of an EMR system in the patient care space? Will it include computerized provider entry? Medication verification?

  • What clinical equipment will send alarms and/or data to other systems? What about links to bed management?

Our goal at Civista was not to answer all these questions right away, but to get the point across that these were issues that needed to be considered. The equipment had to be specific, systems had to be laid out schematically, and equipment and system requirements had to be coordinated. In addition, we needed to allocate space for the devices, purchase the installation tasks, and schedule all of these activities as early as possible to facilitate a smooth start-up.

Whose Responsibility Is It?

When we can handle the coordination of clinical systems integration for a client, we shoulder a burden that typically no one else is prepared to handle as early or with the same amount of technical detail. Some healthcare clients may already have an equipment planner, IT consultant, or engineer on staff who can contribute to this function, or they might have an existing relationship with an outside vendor.

In Civista's case, we combined our technical knowledge and hospital expertise with the hospital's IT staff's capabilities to take on the full coordination and integration of the hospital's clinical systems. The process took about 18 months and was facilitated parallel to the construction schedule.

The Value of Communication

CSII is a growing trend in healthcare and may become a necessary one as more and more hospitals transition to EMR systems. In the past, owners either hired multiple consultants to accomplish the integration, or project teams simply installed separate systems that did not talk to one another. Recognizing the benefit of improved communication, patient satisfaction, and operational efficiency, hospitals are now discovering the value of fully integrating their clinical systems.

It's important for owners to understand that their systems can all talk to one another. It's also valuable for the people managing the process both to understand what is driving the need for CSII and to be familiar with all of the different systems that need to be integrated. HD

Melanie Townshend, LEED AP, is a Senior Project Manager at Gilbane Building Company, where she is currently responsible for the Civista Medical Center project. Townshend has more than 25 years of design, project, and construction management experience in the healthcare and commercial markets.