Working your private Web: The ins and outs of intranets
Here’s some insider information on putting a hospital intranet to work
Some of you are just trying to reduce the paper glut in your hospitals. Others may want to improve communications between the disparate components of your organizations. Still others feel the need for an effective means of disseminating the near-countless varieties of data that can impact hospital administrators, practitioners, and patients.
One of the ways hospitals can get closer to these goals is by setting up an intranet. By making use of this tool, according to knowledgeable industry insiders, hospitals can reasonably expect to gain ground in the never-ending battles against paperwork overload and communication breakdowns, and increase the chances that vital information is near at hand when needed. Others, though, see danger in carrying individual patient data on the intranet.
First, a definition: An intranet is a self-contained information network that limits access to a selected group of users. On a basic level, it is a "private Internet," that utilizes Internet-related tools and technologies, such as HTML (hypertext markup language), TCP/IP (transmission control protocol/Internet protocol), and user access via Web browsers, in order to give it the look and feel of the World Wide Web. But, at the same time, it is a closed system, so that users of the Internet at large are not able to connect and reach the information contained within the intranet. These private networks are differentiated from local area and wide area networks (LANs and WANs) in a number of ways, most markedly by their "open standards" that allow the use of varying hardware configurations and software packages.
Slowly but surely, hospitals are increasing their use of intranets, according to Sharon Lau, a consultant in the Los Angeles office of Medical Management Planning. And they are using these intranets for a number of purposes, she says.
"We have seen that hospitals are using intranets to communicate performance data, such as how the hospital is doing in meeting its improvement goals," says Lau. Departmental Web pages on hospital intranets often function as internal marketing tools. At the same time, "Hospitals are also using intranets to house and disseminate telephone directory and policy/procedure manual information," she says, "as well as forms, so that departments don’t have to keep stacks of these around."
Fast access to information and a reduction in the mounds of paper needed to run today’s health care enterprise are the main gains hospitals are seeking from intranets, according to Lau. "The major benefits of a hospital intranet are ready access to data without having to go find manuals that aren’t there when you need them, as well as eliminating some of the paper," with which hospital personnel are typically inundated.
Setting up an intranet
"We turned to technology to help provide us with a solution to the problem of too much paper," says Wendi Holden, intranet Webmaster at Le Bonheur Children’s Medical Center (CHLB) in Memphis, TN. The hospital chose an intranet as a major weapon in its war on paper waste.
As an important first step in planning for its intranet, CHLB officials first struck a balance between a completely centralized system vs. one largely under individual departmental control. Would dedicated staff in the hospital’s Information Systems (IS) department be responsible for all information on the intranet? Or, would individual hospital departments assume the responsibility for the upkeep of their intranet Web pages?
CHLB chose to use a combination of the two approaches, says Holden. "Content is decentralized [i.e., under departmental control], while intranet development and functionality are the responsibilities of IS," she explains. Departments are responsible for maintaining their departmental Web pages, with their respective staffs creating and posting information using Microsoft Office 97 products, says Holden. Meanwhile, Information Services is responsible for maintaining the hospitalwide pages and the patient/parent information pages. Staffing for this function within IS, she adds, includes a 1.0 FTE (full-time equivalent) Web Wizard, along with a 0.1 FTE for PC support.
While the processes of setting up and maintaining CHLB’s intranet project are managed from the IS department, an intranet advisory group handles larger issues, according to Holden. Represen-tatives from several departments make up this group, whose goal is to develop intranet standards and content guidelines. Each member of the advisory group, adds Holden, was trained by IS on Web site planning and design.
CHLB’s Intranet Advisory Group has come up with a series of standards for its intranet. (See "Sample Standards for Departmental Web Pages," p. 88.) In addition, in order to assist in the standardization process, Holden developed standard headers and footers that are used on all CHLB intranet Web pages. "This creates a consistent look which helps make the pages more user-friendly," she notes, "as well as providing for easy navigation throughout the CHLB intranet." (For sample pages, see boxes, p. 86 and at right.)
This kind of standardization is important for any hospital intranet, adds Lau. "Otherwise, you could end up with a million different looks that will make obtaining information on your intranet confusing to users."
Users of the CHLB intranet can access the following items:
- a hospital overview containing a departmental highlight section and articles on intranet content;
- the hospital phone book that also enables associates to page other associates on-line;
- departmental Web pages which contain valuable information related to each department, including hours of operation, staff, services, a calendar of events, and related Web sites;
- an employee suggestions page;
- a news page where associates can access the employee newsletter, press releases, recent announcements, and upcoming events;
- a search engine;
- a forms page where on-line forms can be completed and e-mailed to the recipient — associates can also fill out non-emergency work orders on-line which are routed to the engineering department;
- a video page where associates can view the latest TV and radio ads and "miracle stories" from the telethons;
- safety/training material that can be accessed in slide presentation format with narration so associates can prepare for their annual safety training exams;
- Micromedex Intranet Knowledge Bases, enabling associates to access several pharmaceutical indexes;
- the education department’s CHLB patient education site, which enables associates to provide patient education material to patients in a timely manner;
- Press, Ganey scores;
- a link to Methodist’s Online Link to Information — The Methodist Intranet.
At Minneapolis-based Allina Health System, content on a soon-to-be-rolled-out intranet will revolve around "things that will help employees both do their jobs and understand what their company is all about," says Lee Danielson, manager of Allina’s Knowledge Management Unit. This includes items such as organizational policy/procedures manuals, contract documents, and reference resources, she notes, "but no personal Web pages."
Neither Allina nor CHLB have immediate plans to incorporate any patient information on their intranets, reflective of the mass of legal, legislative, and privacy concerns that now surround patient records. "Patient information is an entirely different area," says Holden, "and completely separate systems are used to keep track of it."
After about one year of operation, the major benefits of the CHLB intranet have included a reduction in the amount of paper floating around the hospital and enhanced communication among CHLB personnel, says Holden. The intranet has also proven beneficial in employee training, she notes, by allowing mandatory training to be undertaken "on-demand" (via the intranet) when an individual employee has time available, rather than having to schedule multi-employee sessions at a single time and place.
And it also appears that intranet usage is broad-based among CHLB’s health care practitioners. "The physicians use it a lot, especially for the Micromedex Intranet Knowledge Bases," she says, "while the nursing staff are making more and more use of it."
On the cost side, Holden reports that the expenses incurred to set up the CHLB intranet were minimal, due at least in part to the use of existing network hardware. At Allina, "We are predicting that one year’s implementation [of The Knowledge Network] will result in $1.6 million in savings," says Danielson, while about $500,000 is being spent on hardware, software, and consultant fees."
The success of an intranet in the hospital setting is not only a matter of page style and content, adds Lau. "It really is dependent on having a champion in the organization who is enthusiastic and has the ear of administration in terms of selling the benefits of an intranet," she says. "It also takes someone who is savvy enough in the information services or decision support area to get the Web pages up and running."
Even these days, many hospital managers may still need a lot of convincing that an intranet is a good idea. "Hospitals need to be willing to let go a little bit in terms of giving employees access to computers, to intranets and, ultimately, to the Internet," says Lau.
"We still see a real tendency to want to limit usage of computers to a few managers or administrators," she notes. But, "there are so many benefits available to every level of staff by giving them access to data and information, that we think this far outweighs the potential problems of people surfing.’"
We are in an age of the knowledge worker, adds Lau, "and we have to help our workers become as knowledgeable as they possibly can be."
[For more information, contact:
• Kim Hallum, Manager of Decision Support, Le Bonheur Children’s Medical Center, 50 North Dunlap, Memphis, TN 38103. Telephone: (901) 572-3000.
• Lee Danielson, Manager of Knowledge Manage-ment, Allina Health System, 1375 Willow St., Minneapolis, MN 55403. Telephone: (612) 775-1376. E-mail: [email protected].
• Sharon Lau, Consultant, Medical Management Planning, 2049 Balmer Drive, Los Angeles, CA 90039. Telephone: (323) 644-0056. E-mail: salau @ix.netcom.com.]
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