BJC HealthCare

Front and center among the current health care reform proposals is the use of information technology to reduce costs, improve quality and ensure patients’ privacy. BJC HealthCare, however, one of the largest and most innovative nonprofit health care organizations in the United States, has been using IT to achieve these objectives since the mid-1990s.

In particular, BJC Healthcare’s Medical Informatics division concentrates on improving health care by implementing innovative, effective information technology applications. The division’s mission is to improve care by “translating data into effective interventions.”

“Our work is clinically focused,” explains Laura Noirot, manager of applications development for BJC’s Medical Informatics group. “We’ve implemented a set of applications – primarily pharmacy expert systems – that capture critical patient data, translate that data into actionable knowledge and make it available to clinicians to assist them in delivering care. Our applications bring important information directly to clinicians with no effort on their part. They also provide ad hoc queries to obtain additional information. These applications are fed continuously by our systemwide database.”  

Data Driven Expert Systems Assist Clinicians and Protect Patients
DoseRanger is one example of BJC’s multiple pharmacy expert systems. DoseRanger is a clinical decision support application that screens drug orders for potential drug dosing errors based on patient-specific information. This application does not require direct physician interaction. Instead, the system screens drug orders in real-time as they are entered into the pharmacy order entry system. Drug orders that fall outside DoseRanger rules generate alerts that are then routed to a designated person – usually a pharmacist. The pharmacist can then assess the validity of the alert based on the drug, the dosage and patient-specific information before approaching the physician about changing the order.

Other BJC expert systems check for potentially dangerous drug combinations, verify that the proper laboratory tests associated with specific drugs are run at the right times, and monitor patient prescriptions to ensure patients with particular diagnoses receive the proper medications before being discharged.

“Data comes to us in real-time from all of our hospitals,” says Noirot, “and is stored in our centralized production database. This includes registration information, pharmacy information, lab information, patient demographics and also vital signs. Our expert systems use these data to detect situations that require attention. Some of the situations are high priority and are sent via pager to the appropriate person so they can be addressed that day or before the patient leaves.

“Various people also use our expert systems to run ad hoc queries,” Noirot continues. “For instance, they might look for things like how many times a particular drug was used, what the outcomes were for a class of patients treated with a certain drug, and even things like identifying patients affected by a recall of a drug.”

These expert systems have proven to be a very efficient and potentially life-saving system.  In 2008, these system generated alerts to clinicians resulting in approximately 18 patient care interventions per day.

Data Growth and System Downtime Demand a New Architecture and Strategy
While BJC’s database-powered expert systems served the organization and its patients well for many years, over time the volume of data residing in the database has grown to more than 100 gigabytes. Moreover, the database was being used for both transaction processing and reporting, which took a toll on performance and led to an unacceptable amount of downtime required for maintenance – as much as 60 to 80 hours a year.

Because the expert systems are so critical to BJC’s mission and to producing positive outcomes for its patients, the organization’s medical informatics division decided to pursue a new strategy to address these issues. BJC solicited the opinions of two outside consulting organizations to assess its current IT architecture and strategies and recommend solutions that would improve their system performance and maintainability, reduce downtime, improve data quality and ensure security.

One proposed solution included replacement of BJC’s centralized database with two servers to separate the transaction processing and decision support functions. The proposed strategy would have required BJC to move its data from the existing database into two databases—one transactional and one reporting.

BJC also engaged Sybase Professional Services to conduct an assessment through the HealthCheck for ASE consulting service package. “Sybase’s HealthCheck for ASE is designed to assess the architecture, configuration and operating environment of customers’ ASE deployments to attain a high-performing implementation based on best practices,” explains Dale Engle, a Sybase Professional Services enterprise architect. “We work closely with our customers’ staff to explore their production systems and to determine if installed Sybase products are leveraged for their best use. In the case of BJC, we worked with the medical informatics team to evaluate their pharmacy expert systems application performance concerns, and to put forth a set of recommendations and an implementation roadmap to address their concerns efficiently and cost-effectively.”

The Sybase consulting engagement led to the key recommendation that BJC migrate from its existing version of ASE to the latest version, ASE 15. The Sybase Professional Services team felt that BJC could most efficiently and cost-effectively address its concerns by upgrading to ASE 15, taking advantage of its partitioning and query processing capabilities. It was also confident that ASE 15 running as three virtual servers on a single machine would provide BJC with the long-term foundation it needed to enable strategic agility and continuing innovation in its mission-critical environment..

“A Clean, Efficient, and Low Risk Path to Accomplishing Our Goals”
“We carefully considered each of the assessments and decided to implement the Sybase proposal,” says Noirot. “Our goal was to increase our performance and drastically reduce our system downtime. In addition, we were working within a strict budget and sought a solution that would also allow us to accomplish our objectives quickly, within budget and in a way that would support future growth and development.

“Separating the database into transactional and reporting databases,” Noirot adds, “would have required us to make significant revisions to our existing applications, something that would have taken us at least six months to a year to do. Freezing the availability of these care-critical applications for an extended period of time was simply not an option. We required a clean, efficient, and low-risk path to accomplishing our goals.”

Immediate, Dramatic Results
Following its decision to upgrade to ASE 15, BJC engaged Sybase Professional Services to plan and ultimately assist in performing the migration. “We wanted to minimize system disruptions and risk during the migration process,” says Noirot. “The result was a virtually transparent migration. When it came time to cut over from the previous database to ASE 15, our systems were down for just a few hours. Most important, we experienced an immediate and huge performance improvement - query response time was slashed by an average of more than 40 percent.”

“Since the upgrade and virtualized architecture, we’ve both improved our performance and eliminated system disruptions. The migration was quick, thorough and painless, and achieved our objectives.”