Hendricks Regional Health builds apps to meet high standards

Hendricks Regional Health (HRH) is a nonprofit healthcare system in Indiana with a medical staff of 250 physicians in over 45 specialties. Four locations include a full-service 160-bed hospital and several medical centers. Patients get compassionate care from highly trained staff using the same sophisticated medical technology found in larger hospitals, and HRH consistently scores above national averages for patient safety and quality of care.

IT helps support high standards

A long-term IBM® Lotus® Notes® and Domino customer, HRH amassed an impressive record of continuous improvement supported by IT, which it strives to continue. To maintain its high operational and quality of care standards, HRH created six new Lotus Domino applications over the past two years, led by HRH application development supervisor Kim Kiefer. All were built using the XPages web development framework available in the 8.5 release of Lotus Domino Designer software. XPages lets developers build web applications faster and with more functionality than possible before.

OR Status Board improves scheduling and communications

One application came about after the hospital’s operating room (OR) team requested a better system for supporting OR scheduling and communications. Wanted was a better way for tracking patients as they were added to the schedule and moved through the surgical process, and for making more real-time information available to surgeons, the OR core team and patients’ families.

The resulting OR Status Board web application compiles information about all patients scheduled and in pre-op, surgery or recovery. Role-based views show just the data pertinent to the viewer. For example, a patient’s family can see the name of just their loved one and his current status. Information is encrypted for security, and only the family has the code to view the details. They can see if the patient is still in pre-op, surgery or recovery, and what post-op room he will be in.

Surgeons can view the whole schedule without patient names to see if the OR is running on time and whether there are any openings for more patients. Manual additions can be made to the schedule throughout the day, and physicians can view it from their offices to see whether there is room for an additional surgery. Support staff can look at this view to see when an operating room will be free for restocking.

The OR core team’s view is shown in a hallway accessible only to the medical personnel who provide care. They can see names and current status of all patients. Useful patient information (such as height, weight and age) is constantly visible as a reference. This shared view of patients and readily available consultation among OR team members help provide the best collaborative care.

Insulin Drip Calculator helps prevent hypoglycemia

An Insulin Drip Calculator application began with a request from the chief of staff. “He’d read in medical journals about commercial systems and wondered if we could develop an application like this ourselves,” says Kiefer. “So we did, because that let us tailor it exactly to our needs.”

“Traditional insulin drip protocols with drip rates set by human calculations on paper are cumbersome,” says Kiefer, “and calculation errors could also occur, sometimes making the patient’s blood sugar drop too quickly. The Insulin Drip Calculator enables better control of the patient’s blood sugar by calculating more precise recommended adjustments in the drip rate. This helps bring the patient’s blood sugar down more gradually, avoiding bigger jumps that can induce hypoglycemia.

This application has been extremely successful in lowering the incidence of hypoglycemia. As attested by Angie Lyon, the Endocrine Nurse Practitioner at HRH, “Glycemic targets are being achieved in over 95 percent of patients, with <1 percent incidence of hypoglycemia. These outcomes are better than what has been seen in the scientific literature.”

Kiefer considered commercial alternatives before developing this application in house. “But they were too expensive,” she says. “Also, doing it ourselves lets us build additional calculators, such as a heparin calculator. For any we create, we can take the human element out to gain better calculations. This is an excellent example of an application built on Lotus Domino to meet specific requirements in a narrow field, and doing it better for far less cost than comparable commercial applications.”

EMS Mobile Protocol guides field treatment

An Emergency Medical Services (EMS) Mobile Protocol web application was created to serve the hospital’s emergency medical technicians (EMTs) and paramedics who wanted online access to field treatment protocols for quick lookups. Aside from putting guidelines right at hand on mobile devices, any updates are quickly available.

This application can be accessed with any browser, whether from a computer or most mobile devices. So for example an EMT conducting an EKG has immediate access to guidelines for managing various scenarios. Or if a situation seems to call for an emergency intubation, protocols for determining when an intubation is required and what tube to use based on the patient’s size are immediately available.

Other communication and information-sharing advances

An Associate Information Site is a portal that gives employees easy, secure access to HR information such as their pay stubs and benefits letters, which are pulled from the payroll and HR system and consolidated. This is especially useful now that everyone is paid through electronic deposits and no longer gets paper records of their pay and deductions. Associates can also access XPages applications such as their performance reviews and professional journals. “With the oneUI theme and Extension Library application layout, we can provide a user experience comprised of multiple applications that feel like one,” says Abby Butts, the IBM Certified Advanced Application Developer for the HRH Lotus Notes and Domino 8.5 environment. “Because XPages is an integration framework we can integrate relational data from three different data stores."

A Provider Portal provides consolidated cross-system views of patients’ clinical information, using the Data Connectivity tools in the XPages Extension Library. Medical history, current medications, reported allergies and other meaningful data can now be accessed in one place quickly via a browser link. “This wasn’t technically feasible for HRH to do until now,” says Sam Bridegroom, Chief Technologist at Bridegroom Technologies, an IBM Business Partner that provides services to HRH.

“This will revolutionize delivery of clinical patient information to hospital staff and vastly improve patient care. Leveraging the Lotus Domino solutions versus buying more reporting licenses for all the associates needing access to this information will also save HRH about $359,000. Creating our own tools to bridge systems took minimal time and avoided having to license hundreds of users for a different tool that would have been immense overkill in terms of features.”

A new Patient Observation application tracks all observation patients and any orders that require a clinician from a non-nursing department. For example, if a patient receives 30 minutes of treatment from a respiratory therapist, those minutes are subtracted from the total billable nursing time because the hospital cannot double-bill for time. This is a regulatory issue that the application solves while also improving communication between the HRH nursing and billing departments.

New applications yield savings and better patient care

HRH has benefited in many ways from its new applications. Cost savings have accrued or are expected. Putting the field treatment protocols online for the EMTs and paramedics will save at least USD 7,000 a year on printing and binding. Online pay stubs and payment histories also save money on printing. Saving six to eight hours quarterly and eliminating document folding, stuffing and labeling envelopes as well as the cost of paper, envelopes and stamps, the Associate Information Site will save about USD 13,000 annually.

Several applications support better patient care. Giving EMTs fast online access to the most current field treatment protocols both speeds and guides best practices. The Insulin Drip Calculator has almost eliminated instances of hypoglycemia. The OR Status Board fosters more efficient, flexible management of operating room schedules, enabling timeliest response to emergent needs and good customer service to patients and their families. The consolidated cross-system view of patients’ clinical information on the Provider Portal leads to better-informed treatment.

In all, HRH can be proud of its ongoing active application development and its new applications supportive of its high operational and quality of care standards.

XPages benefits both developers and users

Abby Butts explains the benefits of XPages: “There are significant advantages for creating new applications. The biggest is speed; we can build a web application faster and with more functionality than before. One reason is that we don’t have to devote a lot of time to making our applications visually pleasing because the XPages oneUI and Extension Library do that for us.

“Less time spent on the user interface lets us focus on building functionality, and we are now adding functionality that we wouldn’t before because it’s much easier. Encryption capabilities protect the security of sensitive information, and users can access everything they need from both desktop browsers and mobile devices.

“We’re using the mobile controls with XPages because it’s cheaper and faster to build a mobile website than an application for the Android or iPhone. Developing for the mobile browser also ensures accessibility on more devices, so our mobile site works on iPhone, iPad and Android devices as well as a regular computer.

“We can leverage tools like Dojo and Java—for example to provide web access to reviews in our Associate Performance Review application. And we’re using repeat controls that let us bring data from two different applications into one screen. This is good for a dynamic data situation where I don’t know how many rows or tables I’ll need to present because it’s different for each scenario. Other tools include formula, JavaScript, and Java Database Connectivity—all within Domino Designer.

“Users benefit from the XPages oneUI and application layout in the Extension Library that give us a common user-friendly interface for all applications. Making our applications both intuitive and familiar in look and feel reduces training needs. In the past, I had to create training materials and do several demos to introduce a new application to users. Now we move the application to production, let users know it’s available and they take it from there. This frees up time for users and for me too, letting me start on the next application sooner.”

Good reasons for staying with the Lotus Domino platform

HRH has had its Lotus Notes and Domino development environment since 1999, with Kiefer and Butts on staff nearly 12 years. Asked why HRH chose to stay with this and keep upgrading through the current 8.5 release, Kiefer replies, “Lotus Notes and Domino is an environment that works, and it’s been around with continuous improvements a lot longer than SharePoint or any other environment. It’s proven itself.”

Sam Bridegroom adds, “I’ve been doing development with Lotus Notes and Domino for 15 years. I can build things amazingly faster in the Lotus Notes and Domino environment and touch more people and deliver more business value than I can with any other platform I’ve ever used.”

To learn more about IBM Lotus Domino and IBM Lotus Domino Designer software, please contact your IBM marketing representative or IBM Business Partner, or visit the following website: ibm.com/software/lotus

Additionally, IBM Global Financing can help you acquire the software capabilities that your business needs in the most cost-effective and strategic way possible. We'll partner with credit-qualified clients to customize a financing solution to suit your business and development goals, enable effective cash management, and improve your total cost of ownership. Fund your critical IT investment and propel your business forward with IBM Global Financing. For more information, visit: ibm.com/financing

© Copyright IBM Corporation 2012

IBM Corporation
Software Group
Route 100
Somers, NY 10589

Produced in the United States of America
July 2012
IBM, the IBM logo, ibm.com, Lotus, Notes, Lotus Notes, and Domino are trademarks of International Business Machines Corp., registered in many jurisdictions worldwide. Other product and service names might be trademarks of IBM or other companies. A current list of IBM trademarks is available on the web in "Copyright and trademark information" at ibm.com/legal/copytrade.shtml