Huntsville Hospital was established in 1895 as a small infirmary serving the growing community of Huntsville, AL. The hospital has become known for its many firsts. It was the first modern hospital established in the Tennessee Valley. It opened Alabama's first onsite employee child care center in 1967. It became northern Alabama's first hospital to open a neonatal nursery. In 1979, doctors on the staff at the hospital performed the first cardiac catheterization in the region. Two years later, doctors completed the region's first open heart surgery.
Consistent with all of these firsts, Huntsville Hospital also has made strides behind the scenes. For example, as part of a larger effort to install a hospital-wide facilities management system, the hospital has installed a computerized maintenance management system (CMMS) from Datastream Systems, Inc., Greenville, SC. When this system becomes fully functional, every facet of building maintenance, equipment inventory and history, asset management, purchasing, and predictive and preventive maintenance, as well as service requests from individual patients, will be automatically documented, communicated to the right people, monitored to completion, closed out, and billed. Everyone in the hospital--patients, doctors, nurses, employees, and even contractors--will have some contact with the system and will benefit from its broad perspective on automated, integrated service.
Re-engineering maintenance management
After operating for over 100 years and completing dozens of expansions, Huntsville Hospital today is a public, 901-bed, not-for-profit facility comprising Huntsville Hospital and Huntsville Hospital East. The medical staff includes more than 450 physicians representing 55 medical specialties. Joining them are 4100 employees, including a maintenance staff of 70 people.
A few years ago, Huntsville Hospital began the process of completely re-engineering the service aspects of its operations. "The goal was to remove all of the stumbling blocks that kept our service personnel from doing what they do best," says Dave Spurlin, support services network manager. Those stumbling blocks range from receiving instructions to chasing parts to doing paperwork, and more.
At the same time, the hospital was overdue for a new CMMS. Several needs were identified. The staff wanted a system that could provide "the full spectrum of maintenance functions normally associated with operating a facility," says Spurlin.
The hospital wanted a system that would provide an open platform for multiuser operations, information sharing, adaptability, and administrative resource sharing. "We needed a tool that did more than just maintenance; we needed a facilities management tool that included automated work order dispatch, inventory management, purchasing control, and provisions for tracking more than one person per work order," continues Spurlin.
Because of its focus on integration with existing systems, the hospital wanted a maintenance software supplier that was experienced in providing custom work and implementation services.
Keys to facilities management
After an 18 month search concluding in June 1995, Huntsville chose Datastream's MP2 Enterprise. A little more than a year later, the hospital has begun integrating the CMMS with three other independent systems. Together, these four systems make up the hospital's facilities management system.
The Building Information System is a high-end computer-aided design product from Intergraph Corp. It provides detailed drawings of everything from the layout of patient rooms to the area of a new facility. It links objects shown on blueprints and other drawings to lines of information in a database, thereby giving technicians easy access to information about any subsystem in the hospital, including piping and electrical specifications, locations, vendors, model numbers, and technical diagrams.
The Building Automation System constantly monitors and controls the critical process systems within the hospital, including chillers, boilers, power systems, elevators, and heating, ventilation, and air conditioning (HVAC). It supports local and remote equipment setup, alarm management, and equipment control. The Building Automation System involves four suppliers: Automated Logic, Control Systems Inc., Landis & Gyr Power, and Trane Co.
The CMMS monitors and manages the maintenance of both nonclinical and clinical equipment throughout the hospital. "We're talking about physical assets," points out Spurlin. Nonclinical equipment includes systems for power distribution, emergency power, chilled and hot water, HVAC, and refrigeration--even the hospital kitchen. Clinical equipment includes ultrasound and dialysis machines, defibrillators, laboratory equipment, and other devices used by medical practitioners.
The core of the facilities management system is the Advanced Patient Response Platform (APRP), a highly sophisticated automation system developed and designed by Huntsville Hospital. It is used in several hospitals nationwide. APRP operates like a giant dispatch system, explains Spurlin. "It takes service calls from all over the hospital, regardless of what that call is and where it comes from, and routes it to the appropriate person and system."
The four systems that make up this facilities management system run on four Hewlett-Packard dual-processor servers: two LH100-2 servers and two LC133-2 running a mix of Microsoft Windows NT 4.0 and Unix operating systems. Client systems include approximately 30 Pentium workstations and more than 70 interface stations dedicated to APRP. The Pentium workstations are multifunctional; APRP terminals communicate to the other systems through the APRP interface.
Integration is accomplished through a data network running three protocols: Novell Netware IPX/SPX, Microsoft NetGUI to perform directory services, and Microsoft TCP/IP to link databases. The databases include Informix for the Building Information System, Oracle for MP2 Enterprise, and Microsoft SQL Server for APRP. All systems share a common set of Oracle tables, which provide the primary means for the applications to communicate.
The facilities management system will work to benefit patients, visitors, the maintenance department, and the hospital staff, as well as increase the overall responsiveness of the hospital.
A patient wanting a fresh pillow pushes the APRP button (similar to a call button) beside the bed. This call shows up as a request for service at the Patient Response Center. Personnel at the response center talk to the patient, determine the patient's needs, and follow an automated process displayed by APRP to determine the most appropriate person or department to handle the request. Once the selection is made, APRP automatically transmits the request over a pager system to the appropriate person or department.
Dispatching service requests is only part of the story. All patient care employees wear a sensor device that hangs from their name badge. For example, when a nurse walks into the patient's room to deliver the pillow, the sensor automatically identifies the nurse for APRP. If the system determines that the nurse matches the individual assigned to the open service request, APRP will terminate the service call and log the service request as complete.
If the service request is maintenance or biomedical related, the Patient Response Center instructs APRP to create a maintenance service call and transfer it to the CMMS. The system assigns a work order number to the request, creates the work order, assigns a technician, and sends the work order number back to APRP. APRP dispatches the service call over the pager system with the work order number and the location for service. The entire process usually takes 5 to 10 seconds.
A maintenance technician reading the service call on a pager can walk to the nearest terminal--located in strategic areas throughout the hospital--to access the CMMS directly for more detailed information. The portable sensor devices also monitor the movement of maintenance personnel and equipment throughout the hospital. APRP can automatically communicate the relevant maintenance-related movements of both people and equipment to the system.
Once the work order has been completed, the technician goes to the nearest touch screen terminal to close it. The technician can initiate a purchase order from the terminal if the work order cannot be completed because spare parts are not in stock. "The CMMS documents the service requests from a maintenance history standpoint," explains Spurlin. "With that, we now have a means to track the number and type of work order requests, as well as a better method for scheduling preventive maintenance on pieces of equipment and areas of the hospital needing emergency or routine repair."
Saving money, satisfying regulatory agencies
"When integration of the CMMS with the other systems is complete, we will have created a totally paperless system for our maintenance operation," continues Spurlin. "With 14,800 inventory items and nearly 38,000 issued work orders to date—over 100 per day—the CMMS and APRP link is invaluable to our hospital's success."
To date, the system has successfully put a lock on inventory. Because of its growth and continual expansion, Huntsville Hospital routinely hires outside contractors for construction projects. Often, these contractors pulled equipment and tools from the hospital's inventory without documenting their use, causing an enormous problem for the hospital maintenance staff who were unable to account for inventory. Now, contractors can access the CMMS along with the hospital's employees. And like those employees, the contractors have a tool to track all inventory items.
The CMMS also controls contract work. Work orders displayed are essentially the contractor's purchase order to proceed with the job. If the job is not on a work order, the contractor does not get paid for it. "Now we have a way to keep track of billings and contracted maintenance work. Plus, our inventory shrinkage has been drastically reduced, immediately saving the hospital $7200," says Spurlin.
Other information on line lets the maintenance department forecast future work load and schedule work appropriately. "I can avoid having 300 hours of labor available for a 600 hour load. Before, I wouldn't know about this until the paperwork came off the printer," says Spurlin. Work schedules can be adjusted 90 days--even 6 months--in advance. Maintenance not only stays on schedule, but the hospital is freed from paying extra in overtime or contract labor.
The CMMS also has done its duty as an analytical tool. "It shows us exactly how much time we spend chasing parts," explains Spurlin. "And it has shown where we can easily save $50,000 by improving the way we perform maintenance."
Huntsville Hospital also purchased several optional modules for the CMMS. The Occupational Safety & Health Administration (OSHA) database, for example, can print references for major certification inspection requirements directly from the CMMS, information that would have taken weeks to acquire without the data-base.
OSHA is not the only regulatory agency concerned with maintenance documentation. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO), which accredits hospitals, views equipment maintenance as essential to the safety and well-being of the patient. JCAHO's view is that if the paperwork and documentation are not done, the job is not done, regardless of how many people are saved. And the legal system agrees; maintenance documentation is absolutely crucial from a liability standpoint.
Huntsville Hospital is realizing its main goal of creating a seamlessly integrated facility management system. "That brings us back to the issue of openness," says Spurlin, "aided not only by the design of MP2 Enterprise, but also the openness of the company's staff to work with us in making this system work."
For example, at the request of the hospital, custom menus and screens were created, making them easier for the entire hospital staff to use. Similarly, touch screens were installed as a user-friendly feature of the terminals. "The seamless integration of the CMMS into our existing facilities package will make the hospital even more responsive to maintenance-related needs and issues," concludes Spurlin. MT
Information supplied by Datastream Systems, Inc., Greenville SC; telephone (800) 955-6775.