Building and Growing a Hospital Intranet: A Case Study
Kenneth R Ong; Michelle Polkowski; Geoff McLemore; Mark Greaker; Malcolm Murray
Saint Vincent's Catholic Medical Centers, Department of Information Systems, USA
(J Med Internet Res 2001;3(1):e10)
Intranet, Internet, Hospital, Medical Informatics, Healthcare Informatics
Hospitals are rapidly adopting Intranet technology. According to a survey by PriceWaterhouseCoopers and Zinn Enterprises, the proportion of large hospitals (number of acute care beds greater than 500) with an Intranet rose from less than half of the respondents in 1999 to nearly three-quarters in 2000 .
This paper describes the first phase of Intranet growth in a hospital system from October 1999 through July 2000. We describe the challenges encountered, solutions created, and resources brought to bear to develop a dynamic, enterprise-wide Intranet.
Saint Vincent's Catholic Medical Centers of New York (SVCMCNY) is a newly merged enterprise of seven acute care hospitals with services that include a wide spectrum of health care. The system includes 2,600 acute medical/surgical beds, 61 primary care, behavioral health and ambulatory care sites, 800 long-term care beds, 1 million home care visits, approximately 2,000 physicians, and 15,000 associates. SVCMCNY serves communities in Brooklyn, Manhattan, Queens, Staten Island, and Westchester.
The first phase of the Intranet project was limited to the services and settings of care affiliated with four acute care hospitals in the boroughs of Brooklyn and Queens in New York City.
The Intranet comprises a variety of resources, infrastructure, and software (Table 1).
The Intranet project team comprises a project manager, a webmaster, and a technical lead. At present, the webmaster also designs and develops the Intranet. Departments, with sites on the Intranet, have content providers that send digital content to the developer.
Internet Explorer 5 is the standard web browser and FrontPage 2000 the supported HTML (hypertext markup language) editor.
Each department with an Intranet site has a content provider, who must ensure that the relevant department chair has approved material before it is sent to the developer. Content is sent via e-mail. Hardcopy photography is accepted but paper-based text for optical character recognition is not.
Site statistics are monitored with WebTrends Log Analyzer  and FrontPage 2000's report function.
At the end of this first phase of the project, the Intranet has 267 MB of files. At the time of writing, 3,011 files have been posted in the last 30 days. The remaining 1,230 files have not been modified in over 72 days. Of the 5,447 hyperlinks, the majority (5,088) is internal and a minority (359) is external.
A frameset is used to facilitate navigation with links to the main department sites, such as the 'Administrative Manual', 'Library', 'Phone Book', and the 'Physician Gateway' (Figure 1).Figure 1. Example Frameset
The home page has links to a 'News' page with the latest corporate announcements. For example, the current version of 'News' has information and links to resources on Ambulatory Payment Classification and a news release about a prostate cancer screening campaign.
Functions served by the Intranet include those shown in Textbox 1.Table 1. Intranet Resources, Infrastructure, and Software
|Resources||Position||Intranet Project Team Role||Time devoted to Intranet (full-time equivalent, FTE)|
|Director, Medical Informatics||Design, development, and webmaster||0.5|
|Director, Data Administration and Security||Project manager||0.1|
|Network Coordinator||Technical lead||0.1|
At the time of writing, the Intranet has had 890,253 hits with an average of 3,091 hits per day. The total number of visitor sessions was 24,251 with an average of 84 per day. The total number of unique visitors was 819, of which 74 per cent (608 of 819) had visited more than once. About a third of the visitors (276) visited 10 or more times. The greatest proportion of total visitors (45%) viewed three pages.
Excluding hits to the home page, the departments receiving the most visitor sessions (defined as greater than 1,000 visitor sessions) were the 'Library' (6,130), 'Physicians Gateway' (2,539), 'Marketing' (1,321), 'Information Systems' (1,241), and 'Nutrition' (1,221) (see Table 2).Table 2. Departments Receiving the Most Visitor Sessions
The average number of visitors per day was 105 on weekdays and 59 on Saturday and Sunday combined. The most active day of the week was Wednesday and the least Saturday. The most active hour of the day was from 2 PM to 3 PM and the least from 5 AM to 6 AM.
The Intranet has succeeded in becoming a tool used on a daily basis throughout the enterprise. It serves both business critical and patient care functions. The Intranet garnered more than 800,000 hits in its first phase. More than 500 visitors have visited more than once. Content at the end of this first phase includes a gamut of resources from an administrative manual to online training.
This mirrors the success of Intranets elsewhere in healthcare. Intranets have been used to support clinical practice guidelines , radiology test results , disease management , paging services , and a link between emergency departments .
The project costs in resources, software, and hardware were modest in comparison with other similar Intranet projects . An existing network, server, and Microsoft software license cut Intranet project costs. The 0.7 FTE resources, less than $70,000 total for the first year, were in-sourced. In contrast, one price advertised on the web for Intranet start-up design and development is $7 per user per month . At this price, an Intranet distributed to the 5,000 users in phase one of our project, could have cost $420,000 .
One limitation of our analysis was the inability to determine use by different segments of the audience. Intranet was designed to permit access by all staff and associates ('Anonymous browsing allowed' in Internet Information Server 4.0). Individual logon was not necessary for access. We were therefore unable to stratify use in terms of physicians, nurses, administrators, and others.
"Build it, and they will come." It may have worked for Kevin Costner in the movie "Field of Dreams", but chances are this philosophy alone won't work for your company's Intranet. - P.G. Daly .
As with any innovation, at the outset, the Intranet was not adopted immediately . Early adopters provided content to the Intranet and promoted its early use by physicians. The medical library director asked that web-based and web-enabled resources be put online. The clinical chair of medicine requested that the physician order sets and clinical practice guidelines be made available online.
Content spurred use by other staff groups. The nursing coordinator for patient education worked to create material for the most common conditions and illnesses. The Nutrition department submitted training presentations.
The project team webmaster and leader actively sought content and marketed the Intranet in one-on-one meetings with department and corporate leadership. As influential early adopters made the Intranet their own, more stakeholders and departments showed interest in the Intranet.
Though adoption may have been the principal barrier, solutions for other challenges were no less critical to the Intranet's performance and survival. The Intranet project team faced a number of challenges.
If the content submission and turnover continue to grow, several options will be considered. We are currently experimenting with a method that permits Marketing to publish content directly to the Intranet without the need of an intermediary, for example, form posting to an HTML file. Alternatively, content submission and development could be limited to once or twice a month rather than weekly. Finally, more resources may be needed in Intranet design and development.
With successful completion of the first phase of the Intranet project, the second phase will have three goals:
Intranet technology is readily available and is, if pre-existing resources are already in place, of modest cost. Adoption was the key barrier to diffusion in our project. By demonstrating how the Intranet can serve business critical and patient care needs, we were able to empower early adopters. The Intranet has succeeded in reaching the early majority and has evolved from a cutting edge technology to an everyday tool.
We would like to thank the 'early adopters' whose enthusiasm and content that fueled the first phase of the Intranet: Joan Napolitano (Director, Medical Library), Dr. Melissa Schori (Clinical Chair, Department of Medicine), Jeff Flaks (Initiative Leader, Success Agenda), Cindy Miller (webmaster, Department of Quality Assurance), and Renu Sethi (Manager, Nutrition).
Downloadable Screenshots of the Intranet [PowerPoint ppt file, 2 MB]
|Submitted 02.08.00; peer-reviewed by R Rodrigues, H van der Slikke; accepted 18.01.01; published 17.03.01|
Please cite as:
Ong KR, Polkowski M, McLemore G, Greaker M, Murray M
Building and Growing a Hospital Intranet: A Case Study
J Med Internet Res 2001;3(1):e10