Meraz Nasir, director of technology services at Pompton Plains, N.J.-based Chilton Hospital, discussed how his hospital went about implementing single sign-on technology. In this Q&A, he covers why his organization decided to implement single sign-on, how the implementation went, and shares some of the lessons he learned throughout the process.
When did your organization make the commitment to implement single sign-on technology?
Meraz Nasir: When we came on board in 2011, Meditech['s single sign-on product] had already been implemented in the ED [emergency department] and one of the team's charters was to complete the entire electronic medical record deployment. I was prepared for a certain degree of pushback from the clinical community, as they were not happy with the workflow disruptions that were being caused by all the passwords they needed to access their patients' information. Dr. [Richard] Weinberg, our CMO [chief medical officer], had exposure to SSO [single sign-on] at his previous hospital and had been impressed with the way it improved productivity. He considered it a "clinician satisfier" and we saw it as a way to speed the adoption of EMRs [electronic medical records] here at Chilton Hospital.
Meraz Nasirdirector of technology services, Chilton Hospital
We knew that in order to win the users over, we would need to make the new system conducive to their workflows, and not let logons and logoffs get in the way of their patient care. So, after considering various options, in August 2011 we purchased Imprivata OneSign and started to roll it out in conjunction with the rest of our Meditech modules. By February 2013, we had completed the clinical workstation deployment, and today we have 1,400 physicians and nurses using SSO to access 84 different applications.
I would say our clinicians' satisfaction with IT -- and technology in general -- is much higher today than it was in 2011. In fact, the medical leadership, on their own, recently decided to mandate CPOE [computerized physician order entry] for all active physicians by July. To me, that says something about their eagerness to adopt electronic records.
How has the implementation impacted staff productivity?
Nasir: Doctors and nurses want to be able to focus on practicing medicine -- not on technology. In the beginning, they saw SSO as yet one more technology that was going to take time away from treating patients. Then once we began deploying to the first groups, the others saw the benefit and realized that it would actually improve their workflows, allowing them to spend more time with their patients.
While we haven't undertaken any formal time study calculations yet, if we estimate loosely based on the statistics we have, the productivity gains are quite significant. We averaged 70,000 logins last week for Meditech alone. If we consider that two seconds are saved on each login, and that is conservative, then SSO is saving Chilton 39 hours each week. That is time that can be spent treating patients. Not only is that good for the institution, it means that our care providers are spending their time as they should be, and that makes them happy.
What are the key lessons learned?
Nasir: The tricky part for any technologist is to understand the clinical workflow and carve out a solution that enhances patient care. It's really impossible to anticipate the needs at the bedside if you aren't a care provider who has been in that situation. On the other hand, most clinicians don't understand the technology -- and don't want to understand the technology. In some ways, they would just like it to be invisible and not interfere with them doing their jobs.
Our success in deploying this, and other solutions at Chilton, is largely due to commitment, from the top down, on both the clinical and IT side. In many hospitals, bringing the clinical team on board with any major technology initiative can be difficult. At Chilton, we have spent a lot of time listening. We have hired clinical people on the informatics team, some who still spend a portion of their time working in clinical roles. Although they have entirely different functions at the hospital, the IT department and clinicians share the same mission of the hospital: to promote wellness and provide compassionate care and healing. The IT department's role in that mission is to deliver solutions that enhance the care delivery process. Our physician and nursing leadership have an appreciation for the fact that we can help them be more efficient and effective in treating their patients. The strength of the relationship between the two groups has enabled us to better understand each other, and that helps us both succeed. Collaboration from the start will make things easier in the future.
We took a methodical approach to our implementation, and that worked very well here. First, we brought an Imprivata engineer here for a week to train us and allow us to become acclimated to the product. Together we profiled a few of our core applications and rolled them out within IT. Then we began rolling out to the clinical areas. Through our IT team, the clinical deployment was led by the nurse manager for clinical informatics who is an RN, and she worked with members of the clinical informatics user group, who were super users for each unit. We also had IT staff on the floors to enroll users and troubleshoot, so we had all our bases covered. Investing the time upfront to familiarize the IT team with the solution, then transferring that knowledge to key clinicians in each unit will pay off with a smooth rollout.
What were the key IT and clinical drivers for implementing SSO?
Nasir: Security and convenience were the drivers for implementing SSO. From the IT perspective, like any hospital, Chilton has many shared workstations, which make it a challenge to protect data. Physicians and nurses want to do the right thing when it comes to security, but they can't let security get in the way of treating their patients.
It is tempting to share passwords -- or write them down on sticky notes -- in order to speed care delivery. We needed to find a way to eliminate that temptation. On the clinical side, we had to find a way to make it convenient for users to access the information they needed to treat their patients while complying with HIPAA.
What were the key criteria in the product/vendor selection phase?
Nasir: We looked for a solution that was straightforward; technology we could get our arms around in a short amount of time, and then maintain on our own. It was important that the solution could be integrated with other technologies, like desktop virtualization, down the road. The vendor's track record and reputation were critical, and Imprivata stacked up well there. We felt we were in good hands with them.