A lot of organizations talk about ‘building for the future,’ but at Palomar Health, it’s more than just talk. When it came to the design of the new 288-bed Palomar Medical Center, CIO Paul Peabody and his team focused on implementing a solid infrastructure and network that could support not just current technologies, but future innovations as well. In this interview, Peabody talks about the importance of “future-proofing,” what it takes to create a single source of truth for each patient, and his feelings on the best-of-breed approach. He also discusses the dynamics of the CIO’s relationship with the CTO and CMIO, Palomar’s HIE activity, and the organization’s clinical application environment.
- About Palomar Health
- Building the hospital of the future
- Landing a Black Hawk on the roof
- The CIO’s role in new hospital construction
- Getting Wi-Fi in the Healing Gardens
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We had an opportunity to build it from the ground floor up and take a look at how we could improve the healthcare delivery process for our patients and improve the quality. There’s a lot of technology in the building and an infrastructure that allows us to build for the future.
Initially it was thought that we could get some bleed from the interior to the exterior and that would meet our needs, but it’s not good enough. So we’re going to put access points outside and make sure that that coverage is solid.
We have two distinctly different entry points, and we’re able to distribute our network load across those two different networks, plus have the redundancy of a backup network. You want to make sure that you have enough redundancy built in, and I think we did — and we did so very cost effectively.
The nurse assistant for that patient is profiled in the system, the backup nurse for that patient is profiled in the system, and the charge nurse is profiled in that system. So that is the single source of truth in terms of the schedule of caregivers for a given patient.
When a discharge order is entered, it’s routed through the TeleTracking system to be able to get to a case worker or a registration person who has to take care of the next step of that discharge event. So there is a lot of integration that would not be possible without that backbone of technology existing.
Guerra: Good morning, Paul, looking forward chatting with you about your work at Palomar Health.
Peabody: Good morning.
Guerra: My first question is, is there a difference between Palomar Health and Palomar Pomerado Health?
Peabody: Well, we rebranded. It’s a new name. Palomar Pomerado Health was really kind of a mouthful. I think people called us all kinds of things. We decided to simplify it to simply Palomar Health, and then the various campuses have different names like the Palomar Medical Center, Palomar Health Downtown Campus, or Pomerado Hospital, but it’s simply Palomar Health. I think it simplifies things for us a lot.
Guerra: Well, in the long-term maybe, right? But there are the short-term explanations.
Peabody: Oh yes, absolutely.
Guerra: It created a question for me, so anyway. Great, so now it’s Palomar Health now. You’ve been there a year and a half so that’s good for people to know, and we’ll get into that a little bit down the road. But give us highlights of the health system — number of hospitals, etc. The biggest one, it looks like, has 319 beds. Take us through the highlights of the health systems so people have an understanding of your organization.
Peabody: Up until just a month ago — actually on August 19, we opened up our brand new facility, and up until that point we were two hospitals. We have a number of express care centers and a number of ambulatory centers, so we are a growing healthcare organization. The flagship hospital we just opened is just a phenomenal facility. It’s been called the hospital of the future, and we had an opportunity to build it from the ground floor up and take a look at how we could improve the healthcare delivery process for our patients and improve the quality. There’s a lot of technology in the building and an infrastructure that allows us to build for the future. That facility is 288 beds; they’re private beds and single rooms.
We have 44 emergency and trauma rooms and 11 operating rooms. The operating rooms are expandable; they can contract or they can become larger depending upon the needs. We’re the trauma center for this area and we’re a district hospital in California. We cover 800 square miles in northern San Diego County. So we have a large reach across the northern San Diego County. The new hospital with the 44 emergency private rooms and the trauma rooms has an elevator directly that goes up to the eleventh floor, and up on the top is where we land the helicopters coming in. We could land a Black Hawk up on the roof. Of course this is a military community here, so we took that into account.
Guerra: So that could actually happen?
Peabody: Oh it could, sure. Absolutely.
Guerra: What’s a scenario that you can envision where a Black Hawk would have to land?
Peabody: Well, it could be somebody coming in, let’s say the President’s visiting the area. That’s a possibility, because it’s a trauma center so it could be a designated center to bring a president in case of an emergency and you could envision where a military personnel could be bringing them in.
Guerra: Very interesting. Now you’ve been there a year and a half. I don’t know how long these things take in terms of construction of the hospital from when somebody first gets the idea. But tell me at what stage of this project you came on board?
Peabody: A little over halfway, because it was a four-year construction project. It was actually seven to eight years in the making from the time that the bond issue was approved and the design concept period to the beginning of construction, and four years of construction.
Guerra: When you came in, a lot of things were set, of course. You weren’t there at the beginning with the planning stages. I’m curious as to the CIO’s involvement with a new hospital in terms of working with the architect — how that interaction occurs. When you came in and saw what was going on, is there anything you adjusted that you wanted to make a little different than the path it seemed to be going down as far as the new hospital?
Peabody: No, I think it was really well thought out at the point that I entered. It has a lot of solid infrastructure for us to build upon. For instance, the network itself — the wired network — is a 10-gigabit fiber backbone that allows us to deliver a gigabit of bandwidth to each and every PC in the hospital.
The wireless network is solid. But I did make a change there — we’re going to extend the wireless network outdoors to the exterior of the hospital, because being in San Diego, the structure is rather unique in that it has in the middle of the facility, a glass structure that juts outside of the exterior of the hospital. It extends outside and it’s glassed in partially but sunlight comes in and fresh air comes in, so there’s plant life out there. We call these the healing gardens. We want to get patients out of their beds, if they can, and out into these environments that are bright and restful and peaceful to allow them to heal faster. We need to have wireless capability out there, and we didn’t have it. We’re just putting it in now. So that’s a change that I made — getting it out into those areas, because it supports the systems that we need to support the patients out in those areas like wireless monitoring and those types of capabilities.
Guerra: It might be a place a physician would like to sit for a few minutes, right?
Peabody: Well, sure. There are a number of outdoor areas. There’s the healing gardens in the middle and there are terraces on the ends of the building that will predominantly be used by staff. And then we have a third floor outside terrace, a beautiful terrace outside of the cafeteria where people can go out and eat and relax. And all of those areas I want to put on a Wi-Fi.
Guerra: To me, that’s fantastic that that occurred to you. It’s just interesting how you can have tons and tons of smart people working on something for years and years, and somebody kind of misses that. And then if you didn’t catch it, you’d have a patient sitting there trying to check their email or something getting really frustrated, saying ‘why can’t I get e-mail in this day and age,’ right? It’s just interesting.
Peabody: Exactly, but the really important aspect of that is the wireless monitoring system, because we’re working with a company called Sotera. It’s a San Diego based company. They have developed the first wireless blood pressure monitoring device. And in addition to blood pressure, it measures oxygenation, pulse, heart rate and respiration, so a number of things, but they’re the first to be able to monitor blood pressure on a wireless device. It’s important that we have that wireless capability outside so that if they go out in the garden, we can continue to monitor them. So that was one of the primary reasons for doing it. And then of course the other aspect of it is that we have an alert management system that we implemented where nurses are notified of various events on their wireless phone. So obviously you have to have Wi-Fi capability to be able to get a message to that phone.
The exterior areas of the building are important as well, so we’re working on that. I think that initially it was thought that we could get some bleed from the interior to the exterior and that would meet our needs, but it’s not good enough. So we’re going to put access points outside and make sure that that coverage is solid.
Guerra: It’s interesting, when you’re building a hospital with the rate at which technology is advancing, as you mentioned, these things are projects that take five, six, seven, eight or more years. And at the beginning, you set certain things in stone that really can’t be changed five years down the road — actual physical things where there are certain limitations in terms of adjusting them, so you really have to do a lot of thinking and place your bets. I wonder if you want to comment on that dynamic of building a new hospital with the rate at which technology is advancing.
Peabody: Sure, absolutely. You worry a great deal about those decisions and making the right decisions, but I think in this case we’re going to be in pretty good shape. For instance, the primary network that we put in is a 10-gigabit backbone. That is sufficient to carry the load of images that we have, and of course digital images are just continuing to grow. But I’m not concerned about our ability to efficiently carry those images. In terms of the external network, we put in two. We put in an AT&T based network and we also put in a network that is supported by Cox Cable company. So we have two distinctly different entry points, and we’re able to distribute our network load across those two different networks, plus have the redundancy of a backup network. You want to make sure that you have enough redundancy built in, and I think we did — and we did so very cost effectively.
On that network — that primary network — we can also support telemetry. We didn’t put in a separate network to support telemetry; telemetry is supported on our primary network, and we worked with our telemetry vendor Philips to be able to do that. That drastically reduced the cost, and I think it makes it much easier to maintain.
We also put in a distributed antenna system throughout the facility and that distributed antenna system allows us to carry cell signals throughout the facility. And we were very fortunate to be able to have all of the cellular carriers — the major carriers in this area — on this network so that they all agreed to put in their base station and repeater equipment to be able to broadcast a stronger signal strength throughout the facility. We have Sprint, we have AT&T, we have Verizon, and we have T-Mobile all running across that distributed antenna system (DAS). What that does for us is not only provide, for our patients and our visitors, excellent coverage for their cell phones, their smart devices, their iPads, and their tablet devices, but now we can start to provide applications for those. For instance, when they walk in to the hospital, we could provide wayfinding. I’m going to look into doing that pretty quickly — being able to give them a mobile app that they can access to find their way around the hospital or perhaps eventually their electronic health record, so that they have it accessible on their handheld device.
Importantly, it also helps us in delivering care to the patients, because now, through the alert management system, let’s say there is a critical lab value that needs to get to a physician immediately. We could route that to the physician’s smart handheld device so that they could be notified instantly anywhere they happen to be in that healthcare facility, as well as outside the facility. But we know inside they’re going to be able to get that message. And we’re going to do that pretty rapidly because we put in a lot of work. One of the things that I worked on when I came in was looking at this alert management system and determining how we were going to do that and how we are going to get that started.
It’s really a phenomenal application because it has so much integration. If could describe that, it starts with a nurse call system. The nurse call system profiles a schedule for nursing. A nurse has patients that are assigned to them and that’s profiled in the system, but also the nurse assistant for that patient is profiled in the system, the backup nurse for that patient is profiled in the system, and the charge nurse is profiled in that system. So that is the single source of truth in terms of the schedule of caregivers for a given patient. Now that nurse call system is integrated with the alert management system, the TeleTracking system, the telemetry system, soon to be the Sotera wireless patient monitoring system, and the Cisco wireless phones. And it all works together so that the alert management system takes information.
For instance, if there was a critical event that occurred that was picked up on the telemetry system, it would be routed and sent to the alert management system. The alert management system would then have the schedule of the nurse for that given patient and would alert, through the Cisco Wireless Phone, that particular event. Or if on a discharge, when a discharge order is entered, it’s routed through the TeleTracking system to be able to get to a case worker or a registration person who has to take care of the next step of that discharge event. So there is a lot of integration that would not be possible without that backbone of technology existing.