Individualized Innovations and Technology in Healthcare

Personal Healthcare Technology Sunrise Hospital and Medical Center and the Sunrise Children's Hospital The Sunrise Hospital and Medical Center, which includes the Sunrise Children's Hospital, is an approximately 55-year-old facility located in Southern Nevada; it serves the greater Las Vegas area and the surrounding communities. The Sunrise Health and Medical Center is proud of its quality initiatives to ensure patient safety and comfort, including direct approaches to pharmaceutical safety such as safe medication dosing via smart pump technology, and bar coding on medications.

As well, the Sunrise Health and Medical Center does not discriminate with respect to HIV / AIDS or in any manner related to employment, program participation, admission and/or treatment. Sunrise has been rated as the most popular area hospital for 15 years in patient surveys. As well, Sunrise Health and Medical Center has developed community outreach programs for health education in a variety of areas, often based upon community need. The CAMH 2000 Management of the Environment of Care initiative outlined protocols for hospitals to follow.

Many of these areas have been a point of focus for the Sunrise Health and Medical Center: [1] property and security issues for all patients, visitors, and staff; [2] security incident investigations; [3] security management program and personnel; [4] and identification system for staff, patients, and visitors; and [5] other important security issues. The Sunrise Health and Medical Center has also sought to be au courant with technology innovations.

Some of these include pharmacy automation, for example the use of bar-coding, and the only 'gamma knife' in the area - a non-invasive Cobalt-60 radiation method used in treatment of cancer cases such as metastatic melanomas that have reached the brain. The Sunrise Health and Medical Center is also following all governmental regulations to be in compliance with new governmental programs for hospital funding and financing.

Overall, the Sunrise Hospital and Medical Center, as well as its affiliated Sunrise Children's Hospital are working to not only be current in terms of Hospital Regulatory advisory suggestions, but to be leaders in terms of medical and information technology innovations. Introduction In the following manuscript, the Sunrise Hospital and Medical Center is briefly reviewed, with a focus on the manner in which this health organization has addressed the fundamental criteria of providing the highest quality of care to patients.

The report addresses health system technology and modern updates for such organizations, from needs assessment to work-flow. For any modern health care system, patients are customers, as are their families and the community, and the end goals are the provision of high quality health care to this customer base. However, the wider customer base includes not only the patients, but also the families, and the local community.

Appropriate training for staff includes not only the physicians and nursing staff, but also health trainees, support staff, and employees who must monitor and maintain the information technology (IT), the janitorial staff, and even the diet kitchens, as well as administrators and support staff at all levels. There have been massive recent changes in informational technology, rising new global infectious diseases of concern, such as Ebola, and even HIV / AIDS, and new legislation intended to improve health care.

The Sunrise Children's Hospital and Sunrise Hospital & Medical Center have been the premiere health care centers in southern Nevada for over 55 years. Their focus is to provide integrated health-care services to the community, through service to patients as well as considering the needs of employees including the medical staff of physicians and nurses, and clinical and laboratory staff, and associated technical, information technologists, and janitorial and support staff.

The Sunrise Hospital and Medical Center (SHMC) seeks to provide not only 'measurable quality' but also integrated health care that is cost-effective, as well as being comprehensive. The Sunrise Health and Medical Center views its physicians as partners, and together both physicians and the Hospital seek to provide safe care to each and every patient.

Safe medications, and patient safety, are a priority goal, one aspect of which is being addressed through modern 'smart-pump' technology, as well as through the use of bar-coding for pharmaceuticals and other pharmacy-delivered items of treatment such as intravenous (IV) solutions. As a primary consideration the Sunrise Health and Medical Center is non-discriminatory on the basis of disability, age, race, color, sexual orientation, religion, gender, sexual orientation and health issues such as HIV / AIDS.

This non-discriminatory policy applies to employment, admission, activities, treatment, services, and participation in programs (Sunrise Hospital, 2014a). Stroke management and heart care are only two of the many medical programs for which the Sunrise Health and Medical Center has received national recognition; innovation and clinical excellence are also part of the tradition for which the Sunrise Health and Medical Center is simultaneously proud, with a continued focus on advancement. Over the last 15 years, Sunrise has continually been rated as the patients' most preferred hospital (Sunrise Hospital, 2014b).

The Sunrise physicians and staff have considerable and high-level expertise and training from leading global institutions, and both the hospital programs and ongoing quality initiatives make Sunrise one of the world's leading institutions. The Las Vegas community is also served by the Sunrise Hospital and Medical Center as well as by the Sunrise Children's Hospital; these institutions have established both 'on-demand' community educational programming, as well as more long-term service programs. Community out-reach programs range from support groups and general health/welfare topics to staff development programs.

Direct community programs include: nutritional, diabetic and pre-natal classes; information and training classes addressing both specific disease processes and general health and welfare topics; child safety programs; women's health programs; childbirth preparation classes; student educational activities; health fairs; heart health lectures; stroke seminars and screenings; pediatric advanced life support (PALS) training, cardio-pulmonary resuscitation (CPR) classes, and even driving programs. As well, the educational opportunities offered by the Sunrise Hospital and Medical Center are delivered in both Spanish and English as needed (Nevada Hospital Reporting, 2011).

The Modern Hospital Hospital 'business' strategy is dependent upon and shaped by a variety of both internal and external forces (Devers, Brewster, & Casalino, 2003). To some extent, hospital occupancy rates have been on the decline, although some communities report recent increases. Indeed, insight into the approaches used by hospitals in order to successfully compete can provide understanding of significance to developments in the overall health care market.

Because a hospital's patients are customers, competition has led some hospitals to adapt strategies that parallel those used in retail businesses; these are deemed necessary in order both to retain and to attract consumers, patients, and specialists. For example, hospitals may invest in both out-patient and in-patient services that are increasingly perceived as 'high tech', which may not only be large and expensive investments, but may also be duplication of services that are already available elsewhere in the community.

What are some of the forces shaping the business strategies of the modern hospital, as exemplified by the Sunrise Health and Medical Center? Major factors impinging upon a hospital from the outside include: labor supply; economic and demographic trends; medical technology; regulation; payment methods; behavior of private and public purchasers; and hospital and health plan characteristics, including type and number of any competitors (Luke et al., 1999).

The Sunrise Hospital and Medical Center and its associated Sunrise Children's Hospital have implemented a Mission Plan, which is to 'achieve an unequaled level of measurable quality in the delivery of a continuum of cost-effective, integrated health-care services that are responsive to the needs of the patients, physicians, employees and community' (Nevada Hospital Reporting, 2011). To that end, the support staff, laboratory and clinical staff, dietitians, nurses, and physicians at the Sunrise Hospitals have made a commitment to provide compassionate care that is of the highest quality to patients.

A portion of this commitment includes a focus on safety and quality, through the use of monitoring initiatives. A second portion includes attentive listening to patient (and family member) comments both during and after treatment. Information gathered can be used to make changes and improvements in individual care and various treatment aspects. Informed patients and access to information for patients is an important part of health-care for patients.

As well, the Sunrise Health and Medical Centers are working with both the United States Department of Health and Human Services and the Nevada Hospital Association to submit data on a voluntary basis that can be accessed by patients for additional information (Sunrise Hospital, 2014). Sunrise Health and Medical Center is working to sustain ongoing and initial successes as well as to achieve broader success in many areas. To that end, several new development and implementation strategies are in process.

Some of these include new and sophisticated systems for managing patient information via information technology (IT). Areas that must be addressed for such information technology to work on a system-wide, overall hospital basis include: vendor support and performance; user training and acceptance; interface, hardware, and connectivity requirements; database management and file building; down-time protocols and planning; and roll-out strategies and pilot site selection (Protocare Sciences, 2001). Hospital nursing care is a topic of some importance that is not always discussed in context along with focus on cost control and hospital quality.

It is clear to many that any discussion of hospital quality must include nursing staff, yet such discussions are not always integrated. Issues of effective cost control, quality of hospital care and both performance and levels of nursing care should not only be integrated but be utilized in order to achieve the goals of high quality that are desirable. Obviously nursing, both in terms of staffing personnel and the management/organization of hospital nurses is a critical component of hospital quality, as well as of hospital cost.

To that end, involvement of nurses in hospital quality processes is important overall as well as with respect to hospital efficiency. A positive interaction between hospital management and nursing staff is highly important and has been a focus of study. In contrast, however, in a 1996 report by the Institute of Medicine (IOM), entitled 'Nursing Staff in Hospitals and Nursing Homes', it was concluded that hospital care was not adversely affected by changes in [nurse] staffing patterns or hospital restructuring (Needleman & Hassmiller, 2009).

A topic related to nursing care is the training and hiring of certified practical nurses, or licensed practical nurses. These staff members assist with many of the more mundane tasks in the hospital environment, from tasks such as changing beds to getting ice and water for patients. As well, many hospitals utilize hospital volunteers to bring books to patients and/or simply be available as patient advocates. The precise definition of 'high quality' in the setting of a modern hospital has been the topic of recent discussions.

It is commonly agreed that quality is the goal; however the meaning of quality is less clear. The Hospital Quality Alliance (HQA) is a national collaboration at the public/private level which is designed to assist and encourage hospitals to collect and report, on a voluntary basis, quality evaluation information. However the pertinence of such data is controversial (Shih & Schoenbaum, 2007).

Another such organization, Stoughton Hospital, collects quarterly data concerning hospital quality evaluations from the United States Department of Health and Human Services (USDHHS), as well as local hospital organizations (Stoughton Hospital, 2014). Their report focuses on specific issues of patient satisfaction and quality care that can be utilized for hospital improvement, in comparison of various hospitals with one another; and as an accessible data base for the general public (Stoughton Hospital, 2014).

Research Concerning Hospitals As reported by Ayanian & Weissman (2002), research data strongly suggests that quality of care in teaching hospitals ranges from 'moderately to substantially' better, when compared with non-teaching hospitals. Research has also addressed patient issues, ranging from the use of web-based electronic health records (EHR) to web-based electronic charting records (ECR), personal access to and management of health care records, and effects of identity theft on patient well-being.

A second research study of health care providers found that the use of information technology (IT) in hospitals overlapped with security issues. For example, medical errors might be impacted by or affected by IT, and in some cases hopefully improved, as IT should more precisely identify patients. Other issues examined included the increasing onset of tele-medicine, including monitoring of patients; and increasingly pervasive RFID (radio-frequency ID) use.

Focus also included privacy risk management and privacy policy control; development and design of security access; handling and sustainability of integrity of information; and network security. Research addressing the use of electronic data exchange (EDI) in hospitals raises privacy concerns, as does the sub-contracting of health services, from aspects such as network security and privacy issues as well as fraud control.

Medical research, disaster response, health services pricing, the growth of a networked national health information system, and concerns with respect to data disclosure security are also topics of research (Appari & Johnson, 2010). Both credentials and professional records for hospital personnel are also important. For registered nurses (RNs), the nursing license should be current and valid; there should be evidence of ACLS (Advanced Cardio-Life Support) training, as well as a background in critical care.

RTs - both respiratory therapists and registered technologists - should have the appropriate credentials; RCISs - Registered Cardiovascular Invasive Specialist- and CVTs -Cardiovascular Technologists - should also have the appropriate credentials although some on-the-job training can be permitted if the personnel already have acute hospital experience and/or a cardiology background. This may include operating room (OR) techs, and/or paramedics. In some cases, a preceptor is assigned to a new employee for shadow-training, that might last anywhere from 16 weeks to only 2 weeks.

As well, classes in ICU (intensive care unit) management are also provided. PALS (pediatric advanced life support) training is required for any personnel working with children (Leslie, 2006). The CAMH 2000 document on Management of the Environment of Care raised a variety of concerns in re security for hospitals.

The Sunrise Health and Medical Center has addressed these issues in the following manner: [1] the provision of security education and orientation programs for personnel in areas known to be 'security-sensitive', as well as establishment of processes for reporting security issues, and establishment of emergency protocols; [2] developing, establishing, implementing a security management program and defining critical personnel responsible for said program; [3] ensuring that any security incident is investigated when reported and increasing incident reporting; [4] addressing and identifying any security issue, including incidents in re property, that involve staff, patients, and visitors; [5] identification and clarification of security risk areas and controlling access to such; [6] establishment of a staff, visitor, and patient ID system; [7] making urgent care areas accessible by vehicle and provision of vehicles; [8] security risk monitoring for one or more of the areas identified by the commission; and [9] annual security management evaluation, including definition of a process focused on security effectiveness, performance and scope (Colling, 2001).

In the present health-care system, 66% of hospital revenues come from government-funding according to Foster (2000); the remainder of funds came from private payments, voluntary non-profit organizations, and commercial insurers, as well as local government tax revenues (Baker and Baker, 2000). The immense proportion of hospital funding provided by government entities indicates that a hospital's viability financially is dependent upon funding from government monies for elderly, disabled, and the poor through Medicaid and Medicare. Thus a hospital's fiscal management is necessarily dependent upon appropriate strategy management as well as awareness of potential changes.

Changes in government funding have previously placed certain local and state hospitals at risk (Byington, Keene, & Masini, 2006). Hospital & Healthcare Management Cost reduction for hospitals and other health-care organizations may involve hiring a company for management and central oversight. This may be as simple as hiring a firm that handles services such as accounting and tax processing, but essentially removes the need for a hospital to have several staff members, per department, devoted to such tasks, and generally involves more cost-effective rate services.

This management company can result in streamlining a variety of processes for the hospital, and increased efficiency. Typical management companies receive a monthly fee of the hospital's revenues, which are approximately on the order of 6.5% of net revenues. The services include management of government reimbursement, filing and report preparation; capital planning; internal audits; contracting for managed care; consulting services; budget control systems; financial reporting; accounts receivable management; legal services; and human resources, to include employee benefits.

The corporate office handles taxes, appeals, audits, returns, and reports at the local, state, and federal levels (Nevada Hospital Reporting, 2011). Equipment Down-time and The Hospital A factor of potentially serious consequences for a hospital is the need for any computerized system to have 'downtime'. This may be due to a need for a routine back-up or maintenance; however, important systems that are in use will become non-functional. Employees should be trained in procedures for downtime; hopefully redundant systems are available and operable.

Familiarity with downtime protocols is important to maintain quality patient care (Fahrenholz, Smith, Tucker, & Warner, 2009). Medicare Recent legislation has been enacted to avoid and/or offset upcoming tax increases, particularly for hospitals and with respect to Medicare and the 'doc fix', which would have decreased payments to physicians by some 27%.

An extension, arising from the new legislation has the following provisions: The Coding Offset for Medicare Inpatients ($70 million in Nevada), decreasing payments for 2014-2017 fiscal years; Payment Cut in Medicaid DSH payment - a national decrease of $4.2 billion over ten years, with a provision for extension of the DSH policy for the Affordable Care Act to 2022; a decrease of $300 million nationally over ten years for Radiology treatment of Medicare Outpatients, with exemptions for Rural and Sole Community Hospitals; a reduction in treatments by Medicare for End Stage Renal Disease by $4.9 billion nationally over ten years, adjusting payments to include use of medications.

Awards, Honors, and Distinctions According to the Nevada Hospital Association (2013), Sunrise Health and Medical Center was recognized for excellent care for stroke patients, in accordance with 'evidence-based guidelines'. The American Heart Association/American Stroke Association's Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award applauds the Sunrise Health and Medical Center's quality success and commitment to stroke patients (Nevada Hospital Association, 2013).

The Sunrise Health and Medical Center is also proud of its major investments in modern cutting-edge technology that treats a variety of complex medical conditions, including: the da Vinci Surgical Robot, assisting in surgery, for minimally invasive surgical procedures that also enhance recovery periods; the Gamma Knife surgical center - the use of Cobalt-60-gamma radiation for precisely targeted brain surgery in cases of invasive melanomas, and other brain conditions, via non-surgical methods; the use of highly sophisticated PACS (picture archiving communication system) technology for x-rays, CT scans, MRI's, and other diagnostic scans, on a real-time basis, decreasing wait-time for patients and speedier diagnosis and resultant treatment; and a pharmacy robot as well as pharmacy automation and medication bar-codes, improving patient safety and preventing medication errors.

Health Care Innovations According to Zaltman and colleagues (1973), in order for businesses to be productive and to survive in a competitive environment, innovation is critical. In the health-care arena, there is a need to balance health-care quality with cost containment, leading to a significant push towards innovation. Most recently, RFID, radio frequency identification tags have become increasingly common, with approximately 10% of hospitals using them at present, according to the non-profit consultants of the ECRI institute.

Most recently, JAMA, the Journal of the American Medical Association, warned that RFID tags could possibly cause interference with medical devices in current use. Another aspect of concern for hospitals with respect to the technology of tracking is the potential for personal data to be released inadvertently.

Steps for patient/consumer protection, and examples of high-tech equipment used in hospitals include: [1] Videoscopes (high definition camera signals/television) on equipment used to 'snake' through the body of a patient in order to perform searches for evidence of tumors, to assist in gallbladder surgery, and in colonoscopies (Omachonu, & Einspruch, 2010); [2] Industry-standard data models and technologies for health-care informatics, permitting access and storage via models such as eCHR and ePHR (vide infra); [3] ePHR, electronic Personal Health Record, which is patient-accessible, for selective sharing and recording of health care information; [4] eCHR, electronic Clinician Health Record, which enables health-care providers/physicians/nurses to compile, access, and record health-care information specifically related to a given patient; and [5] novel and increasingly used robot rehabilitation methods of therapy for treatment of stroke, and potentially other future uses.

These innovations are arising from the work of scientists at MIT. Community Out-Reach The Sunrise Health and Medical Center has established a variety of community outreach programs, many of which are accessible through its website (Sunrise 2014). These include such programs as Consult-A-Nurse for healthcare referral, including an app to save the Consult-A-Nurse to one's cell-phone. The program has both nurses and.