There’s perhaps no field that’s undergone as many changes and seen as many advances in the past 20 years than information technology (IT). Consider this: there was a time, not long ago, when computers weren’t a common sight on desktops, except at some nurses’ stations and the offices of a few administrators. X-Rays and other diagnostic procedures still relied on photographic film, while many more of today’s widely-used computer-based diagnostics hadn’t even been introduced. Cell phones were something you might find in prisons, blackberries grew on bushes, laptops were primarily where cats rested and the initials P.C. only meant politically correct.

How times have changed. And, how quickly technology has evolved.

Stephen D. Adams, Pittsburgh Mercy Health System

Stephen D. Adams, vice president and chief information officer at Pittsburgh Mercy Health System, has been an IT professional for 35 years. He’s spent the past 16 of them leading the department at Mercy, and before that, working at Westinghouse Electric, where he managed IT groups.

"I’ve loved every minute of it," he says, adding that the field has not only grown over the years, but has become increasingly complex. "Initially," he recalls, "there was a single IT system in the laboratory and one in the hospital. Then, the IT explosion happened, and it affected every phase of the hospital. Today, virtually nothing is done manually."

"Because of the high degree of complexity and integration," he continues, "we work with a variety of vendors. This keeps things running smoothly and helps us maintain real-time data in the clinical areas." He also points to the consolidation of local healthcare systems in recent years as a factor that’s had a major effect on the IT field. "At one time, each hospital had its own network. As the mergers began to take place, it became necessary for health systems to standardize the networks across their hospitals. "At Mercy, we’re a health system, and we’re also part of Catholic Health Partners East, which includes 31 acute care hospitals, 46 freestanding and hospital-based long term care facilities, 12 assisted living facilities, five continuing care retirement communities, three behavioral health facilities, three rehabilitation facilities, 18 home/health agencies, and numerous ambulatory and community-based health services in the eastern United States. Although our IT systems are standardized, it’s been difficult to accomplish because of the scale. Eventually, the plan is to have a corporate data center that will serve all of CHE’s member hospitals."

One of the key challenges that confronts Adams and his staff on a daily basis is maintaining network security. Computer viruses are a significant problem. "Viruses occur on a daily basis," he says, "arriving in e-mails and also via removable media, like CD-ROMs, that employees bring in from home." To ward off such problems, Mercy’s IT network runs a full complement of anti-virus and anti-spam tools. "What we do is very sophisticated," says Adams, "and it has to be, given our privacy and security concerns related to HIPAA."

When asked about the future of hospital IT, he mentioned the federal government’s strong push for a national health record and President Bush’s appointment of Dr. David Brailer as a cabinet-level technology administrator. "The government is looking at the relationship between hospitals and doctors, and also relaxing some of the laws in an effort to move toward having the record. In fact, a committee has been formed and a Mercy representative sits on it."

He quickly adds, though, that the notion of such a health record isn’t new. "In the early-to-mid 90’s, there was talk about establishing community health records, and there were a lot of initiatives around the U.S. aimed at creating them. They didn’t get too far, because they were mainly grassroots efforts that weren’t pushed as much at the federal level."

Adams sees much more IT growth ahead. "Doctors now have remote access, over secure connections, to such patient information as test results. In April, we began using the PACS (Picture Archiving and Communication System) to do digital diagnostics. Also, we’re now wireless. But, hospitals and health systems are still considerably behind other industries when it comes to IT. We’re not caught up yet. To a degree, we’re still paper-based. We need to get away from paper."

Stephen Adams can be reached at (412) 232-7544 or at sadams@mercy.pmhs.org.

Joyce Polovich, Ohio Valley General Hospital

At Ohio Valley General Hospital, Joyce Polovich has served as director of information management for nine years. She was appointed to that position a year after she joined the hospital as a systems analyst. Before that, worked in a similar position at HealthAmerica.

Looking back over the past decade, she can count the dramatic changes that have occurred in the IT field. "In 1995, there was no PC networking," she says. "The only PCs at Ohio Valley then were the ones in the administrative offices. Our first network only encompassed 20 computers – administrators, assistants and the IT department."

Today, Polovich says, it’s a whole different ball game. "We’re fully connected to the Internet and use wireless technology. In 1996, we put computer terminals in every patient room, which physicians can use to get up-to-date patient information. Now, we’re moving toward having wireless connections in every room, with computers on carts."

Vonday Balkovec, R.N., and Tom Siar, R.N., shown in the critical care suite at Ohio Valley Hospital.

Also, network security has changed in a big way. In 1984, Polovich was working in the private sector with encrypted passwords. However, when she entered the hospital field, she was surprised to learn that employees’ passwords could be looked up. "Only in the last ten years has the hospital sector really focused in IT," she notes. "And it’s evolved, most recently, with HIPAA."

She counts among her challenges the limited dollars hospitals have to spend on IT, especially as payors are cutting back.

"But we do need to keep moving forward – and we are doing that. For example, we’re now barcoding medications. In fact, in 2001, Ohio Valley was one of the first hospitals in the U.S. to begin providing automatic medication administration for patients. This has greatly reduced medication errors and improved patient safety."

The challenge now, she says, is to move to an electronic medical record. "This would provide a great opportunity, especially in eliminating lost records. It would be great for each patient to have a smart card – one we could swipe to get information."

Joyce Polovich can be reached at (412) 777-6515 or j.polovich@ohiovalleyhospital.org.

James Witenske, Jefferson Regional Medical Center

James Witenske is chief information officer at Jefferson Regional Medical Center, having left Arthur Andersen four years ago to accept the position. Before working at the Big Eight firm, he served as chief information officer at UPMC Health System.

At Jefferson, IT takes place a bit differently that at other healthcare institutions. Where most hospitals have an IT department with staff, Witenske works almost exclusively with outside experts, one of whom is Ron Forys, a Siemens site executive who is based at Jefferson. It’s a complementary relationship – Witenske’s role is strategic and Forys’ is operational. Both are longtime technology professionals who have seen huge changes take place during the past two decades.

"One of the biggest," according to Witenske, "is IT’s evolution from a charge capture system for expediting billing, to a system that enables the hospital to provide efficiency, quality and safety for patients. More physicians are using it today, too."

Forys concurs. "Technology has radically changed the hospital environment. Some applications, like PACS, streamline processes. Electronic document management eliminates paper. Now, we can get insurance authorizations via dedicated lines."

However, as others have mentioned in this article – and Witenske agrees – hospitals still lag a bit behind the corporate world when it comes to technology. "I think the percentage of revenue spend on IT over the years has increased. And, it helps quite a bit with physician recruiting, since younger doctors want to work where they have the most advanced tools."

That said, Jefferson has its share of remarkable technological tools in place; among them – Vocera, a small communications device that operates over a wireless network.

"It’s used by emergency, operating room, transfer and other staff," says Witenske. "They clip it on their clothes and can use it to communicate privately with a dispatcher," says Witenske. "It’s a sophisticated tool that was used on the USS Ronald Reagan. It’s voice activated and can convert voice messages to text. It reduces the need for overhead pages, and eliminates the need for beepers and walkie-talkies. Also, it’s HIPAA-compliant."

In addition to the PACS system and wireless computer carts in patient rooms, all patient bracelets, employee identification badges and medications are barcoded to ensure safety and quality. Also, both Witenske and Forys mention the growth of the Internet and Web-based applications as having a major impact on how health care is provided.

In the future, Forys envisions a greater technological focus on workflow. Witenske says there will also be a continued focus on technology in the clinical setting, including voice to text in clinical areas and physician order entry.

Jim Witenske can be reached at (412) 469-5000 or jameswitenske@jeffersonregional.com.