Hospital Shares IT ExpertiseHospital Shares IT Expertise

New York City's Montefiore Medical Center, nationally recognized for its treatment of cancer, heart disease, and psychiatric patients, is trying to gain recognition for another specialty: health-care information technology.

The hospital found that a clinical information and physician order-entry system it assembled worked so well that it now sells applications and consulting services for those systems to other hospitals.

"There's no reason everyone has to learn from their own errors," says Dr. Eran Bellin, medical informatics director at Emerging Health Information Technologies, formerly known as the MIS department at Montefiore Medical Center.

Emerging Health is a wholly owned subsidiary of Montefiore and, in addition to its IT services business, continues to run Montefiore's IT operations.

Montefiore has long taken a progressive approach to IT. The hospital began electronically recording lab-test results about 15 years ago and implemented a physician order-entry system in 1997. Only 3.5% of hospitals nationwide have some type of electronic physician order-entry system, which doctors use to record patient data and order lab tests and medications for patients, according to a study published in April by the Leapfrog Group, a consortium of health-care institutions. "We are one of the few medical institutions in the country that is 100% direct doctor order-entry," says Jack Wolf, who serves as CIO of Montefiore and CEO of Emerging Health.

At Montefiore, doctors use wireless laptops and handheld devices to order medications and check test results. The system is designed for internal operations and doesn't access outside retail pharmacies and labs, for example. It's built on clinical and financial applications from IDX Systems Corp. and laboratory-management apps from Triple G Systems Group Inc., all running on Hewlett-Packard NonStop servers.

Because the clinical information and physician order-entry systems are paperless, it was necessary to create a backup repository of all data, Wolf says. Transactional data from operational systems is constantly mirrored to the repository using data-synchronization software from GoldenGate Software Inc. Immediate failover capabilities kick in if main systems unexpectedly go down.

The GoldenGate software also copies operational data into a data warehouse, based on Sybase Inc.'s database, which administrators, physicians, and hospital workers use to generate reports about the length of patient stays, bed-utilization rates, drug-prescription trends, and other metrics for measuring and improving business processes. Emerging Health also developed a custom application that taps into the data warehouse for conducting research on illnesses and treatments.

But while development of such complex IT operations may be possible for a 1,000-bed hospital like Montefiore, which gets 800,000 patient visits each year, the needed investments and expertise are often out of reach for smaller health-care organizations. "These are things that other hospitals just can't do," Bellin says.

Emerging Health offers consulting services to resource-strapped hospitals assembling their own clinical and physician order-entry systems and resells the IDX and Triple G applications; it also provides those apps on a hosted basis. The subsidiary trains employees on the systems and works with HP for hardware maintenance and service.

Emerging Health provides clinical information and patient billing systems as a hosted service to Bronx-Lebanon Hospital Center, an 800-bed hospital and nursing home, and will soon host a physician order-entry system for the hospital. By contracting with Emerging Health, Bronx-Lebanon chief operating officer Steven Anderman says, the hospital shaved two to three years off the time needed to install the new IT system.