Early Warning System

The hospital's informatics group, a research organization separate from the IT department, designed the system with grant money from the National Institutes of Health. The goal was to create a forecasting tool to improve the preparedness of the emergency room and clinical departments, says CTO Scott Ogawa. The hospital could use the forecasts when setting staffing levels and purchasing drugs and supplies.

"If you think you may have an outbreak of GI gastrointestinal symptoms during a certain month, you might staff more housekeeping," Ogawa says. The system might also predict more orthopedic cases during the spring, when more people are playing outdoor sports in the Northeast, or more respiratory cases during flu season.

The system takes advantage of off-the-shelf data warehousing software that hospital officials would not name and employs ARIMA (AutoRegressive Integrated Moving Average) modeling, a statistical technique that constantly updates its forecasts based on new information, according to CIO Dan Nigrin, who in addition to being a medical doctor holds a master's degree in medical informatics. ARIMA modeling is popular in the financial-services sector, Nigrin says. (For more on ARIMA, see mathstat.carleton.ca/ ~help/sashtml/ets/chap7/sect1.htm.)

Children's was just about to pilot the system and publish the results in a medical journal when terrorists attacked the World Trade Center and the Pentagon. "When 9-11 came, the relevance of this stuff for bioterrorism was obvious," Nigrin says.

Two developers, one of them a medical doctor, spent four months creating an intuitive front end and making the system production-ready.Separately, several departments within the hospital are working with the Centers for Disease Control and Prevention (CDC), the Federal Emergency Management System (FEMA) and other government agencies to devise emergency response procedures in the event of a terrorist attack. A natural outgrowth of this work could be to connect EDScope to data-analysis systems operated by other hospitals.

"Obviously, it's the right way to start thinking," Nigrin says. "That's where practically implementing these systems becomes difficult. Even connecting a small number of hospitals together, the logistics are difficult. Nationally, it's a mammoth effort."

Children's also may enhance EDScope with a geographic information system, letting physicians track symptoms according to patients' home or work addresses. "Let's say on a given day we have double the typical number of respiratory cases," Nigrin says. "Wouldn't it be great to be able to toggle to display a map with red dots showing where the respiratory cases originated? In a bioterror attack, you might get 10 or 20 cases all clustered in downtown Boston."

EDScope cost the hospital almost nothing to produce. The pre-9-11 work was funded by the NIH grant as a research project, and since then Children's has added horsepower using existing server hardware and database software, Nigrin says. Then there was the labor of three people: Ken Mandl, a pediatric emergency physician who oversaw the effort; Ben Reis, a Ph.D. in the informatics group who wrote the ARIMA code and populated the system with historical ER symptom data; and Miliken Tyler, a staffer in the IT department who designed the user interface.

It's a stark contrast to the PeopleSoft deployment, which cost the hospital $14 million, more than half of which went to consultants (see "Child Support", and "PeopleSoft Update" for an update on the PeopleSoft implementation). EDScope "is an inexpensive, small project, but its impact is just as important or is important in a different way," Nigrin says. "An important project doesn't necessarily mean it has to be costly or big."David Joachim is Network Computing's editor/business technology. Write to him at [email protected].

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Since our first visit with Children's, the hospital has rolled out PeopleSoft's E-Benefits module, which lets employees make changes to their health and retirement plans over the Web. Some 2,000 employees used the application during the end-of-year enrollment period, Ogawa says. The application is accessible on the hospital's intranet, which can also be accessed remotely via a VPN.

Children's is also piloting PeopleSoft's E-Profile module, which lets employees update their own demographic information without HR intervention. This is used for changes such as marital status and home address. Also going into pilot later this year is PeopleSoft's E-Pay, which lets employees view their pay stubs and download their salary and tax-withholding data into Quicken, Money or other personal finance programs.

Also under consideration are PeopleSoft's E-Procurement and E-Manager modules. Children's officials previously had hinted they might go best-of-breed for e-procurement software, but their stance has clearly softened. "We're not ruling out going to another vendor, but there's a lot less urgency around that point now," Nigrin says.

Nigrin and Ogawa also say that the usability troubles reported during the initial rollout last April are slowly ironing out. Departments are also starting to abandon their old processes and rely solely on PeopleSoft; last fall some departments, including IT, were clinging to their own databases and sign-off procedures because they didn't quite trust the new system.