Monday, May 19, 2014

SharePoint in the Operating Room

Improving Patient Safety with a Proven Operating Company Model!


TeamSTEPPS is a teamwork system designed for health care professionals that make it a powerful solution to improving patient safety and scientifically rooted in more than 20 years of research and lessons from the application of teamwork principles.  MEDCOM continues to roll out TeamSTEPPS Army wide.  SharePoint is an off the shelf collaboration tool that D0D and the Army has used for over 12 years with mixed results.  SharePoint is largely being used as a tool to store documents.  SharePoint has the ability to be used for a much wider variety of ways such as collection of data for quality control and process improvement.  Integrating SharePoint into hospital everyday practices would allow for improved patient safety, fewer delays, and increased utilization all while saving countless tax payer dollars.  Madigan Army Medical Center (MAMC) is using a postoperative team assessment for over five years now. The success of this assessment tool was published in the Journal of Surgical Research on January of 2013.  The article clearly shows success and a clear value of this assessment tool. The tool has been implemented to over 10 military treatment facilities (MTF’s) Army-wide., to include Brooke Army Medical Center at Fort Sam Houston and Tripler Army Medical Center at Honolulu, Hawaii.

Where’s The Data?

One, Five, Thirty Two

The Army’s Medical Command (MEDCOM) has five regions that reach around the world and 32 MTF’s which includes seven Medical Centers within those regions.  Each MTF with a surgical services line  collects information  about their operating rooms, but the data from each MTF  is inconsistent and the data points very from place to place making it very difficult or even impossible to find trends across MEDCOM.  This presents a challenge when looking for trends and to mitigate potential surgical services problems across the Army.

The Problem


The largest problem is standardization of the data collected so that it can be consolidated at a region and Army level.  Currently each MTF collects data based on their own locally developed questions. This makes it difficult to compare data from one MEDCEN to another.  It also makes it very hard to offer solutions to problems at an enterprise level.


In 2009 MAMC began to collect OR Debrief data utilizing the Survey Option in SharePoint. This electronic format presented many advantages. Staff no longer collected Debrief information utilizing a paper list, and the information was more readily available for mitigation of issues identified and it was easier to track and trend the data. Another benefit to using SharePoint for quality improvement protected data such as this is that access to the data can be limited to need to know and it is CAC enabled for security. This SharePoint based tool has undergone several revisions and the current tool requires fewer steps for work flow and provides a dashboard for quick data reference. The original tool was built for SharePoint 2003 and utilizes a survey and a custom list.  It also requires the user to copy data from a survey to the list which can result in data loss or corruption due to human error.  Another challenge is, despite a requirement for all MTF's to have SharePoint 2010 implemented by January 2014, medical facilities still have older versions of SharePoint ranging from SharePoint 2003 to WSS.  This makes it very difficult to offer a standardized solution that will work for 100% of the Army’s medical facilities.  The lack of the needed skillset of information technology personnel at each MEDCEN and hospital is also another challange.  The learning curve to administer and develop SharePoint and make user friendly tools and apps is steep.  This is often a challenge in setting up the assessment tool at each facility.  The typical Information Technology staff does not know enough to implement this tool successfully.  When the need arises to add a question or choice, the problem is compounded due to the fact that MEDCOM would have to rely on the local IT personnel to update the tool due to current firewalls and limited access to MTF SharePoint sites.

The Solution

In 2012 Reynolds Army Community Hospital (RACH) was the pilot for the MEDCOM Surgical Services Simulation Train the Trainer. This TeamSTEPPS based training included the implementation of Briefs and Debriefs in the OR and the use of the SharePoint debrief tool.  Implementation of Briefs and Debriefs as well as the collection of data from the Debriefs has led to significant improvements in operating room processes and in patient safety.  After using the tool for over a year, the Quality Management Department at RACH was looking for a better way to manage and mine the data from the tool.  The tool was migrated from SharePoint 2003 to SharePoint 2010 and merged into one custom list.  This tool now offers more than a simple interface, but also a mobile dashboard that automatically pulls data from SharePoint and graphs the data by simply entering two dates.

Get Standardized

Standardizing the entire MEDCOM should be the focus. To accomplish that, every facility needs to be using the same tool and data points.  Slight customization may be acceptable, but should not affect or skew the existing data points. Limit the amount of additional questions to patient safety questions to prevent the tool from becoming a repository for other data that is not tied to patient safety or process improvement.

Assessment Tool

By combining the survey and the list into one custom list, we can offer a better tool that is more efficient.  This new tool can offer custom views for faster navigation of issues.  Automation is also available on SharePoint 2010 for assigning issues to the appropriate department for faster resolution of OR problems such as equipment and instrument failures.  The assessment tool is set up as a site on SharePoint that is secured by SharePoint groups.  Generally, OR nurses, surgeons, department chiefs, and the tool administrator are the ones that have access to the tool.  There is no Personal Identifiable Information (PII) or Protected Health Information (PHI) in this tool.

Data Collection

Issues by category
By collecting data in this new format, it’s easier to extract vital information such as equipment issues, staffing, and even time lost.  Data can be easily accessed in Microsoft Excel directly from SharePoint with just a few clicks.  A “Mobile Dashboard” was created to be able to graph the data and to better visualize the issues brought up in the assessment tool.  By adding a start date and end date for the date range needed, various graphs are immediately generated and displayed for the staff and command.  The graph to the left is just one example of how quickly one can see that instrument issues are elevated and require further analysis.  Below graphs shows the number of delays within the provided date range and what attributed to those delays.
The Mobile Dashboard also allows one to see issues reported by a surgical service as well, even across multiple date ranges so that one can see trends.  All these graphs can be completely customized and tailored to the end user’s needs.


This tool is designed to be easy for the end user, and thus takes a bit longer to develop.  By taking the time to develop it with the customer’s needs, the product has been successfully deployed.  With the before mentioned challenges, it would be best to have this tool implemented at a MEDCOM level.  At the MEDCOM level, standardization can be enforced for better performance, faster reporting, and easier data collection at the enterprise level.


Recommend SharePoint Server cluster be set up at the MEDCOM level.  The SharePoint server should be setup with five Site Collections, one for each region.  This allows for expansion and better site performance. Backups need to be done on a regular basis, both full backups and incremental backups. Staff developing the front end will need computers that have Office 2010, SharePoint Designer, Adobe Illustrator, and Adobe Photoshop.  Due to the nature of the listed applications, it is best practice to have Windows x64 bit so that the computer can utilize the entire installed RAM.  The RAM should be 16GB for best performance and an Intel i7 processor.


The server backend should be able to be managed by centrally, at an enterprise level with little increase in personnel work load once the servers are up and running. The site collections, user front end, and mobile dashboards could be managed by two – three personnel once the setup is complete.  For increased staff availability, it is recommended to have more than one person.  The user front end takes about 40 hours to develop for each facility, but can be streamlined with standardization.  The Mobile Dashboard takes about 40-80 hours to develop, depending on customization and facility needs. Within 12 months, all Medical Treatment Facilities with surgical service lines can have the new tool deployed.


By implementing this SharePoint tool Army wide at an enterprise level, MEDCOM can improve surgical service processes, identify trends, better prioritize funding, assign personnel to facilities resulting in a higher impact on patient care, and most importantly increase patient safety.


Matthew Eccles, MCITP,  RACH


Phyllis A. Toor, RN, MEDCOM


Andrew J. Foster, MD, MAMC Nancy J. Gallagher, PSO, BMACH Troy N. Morton, MD, RACH Amber L. Pocrnich, RN, BJACH Christina D. Smith, RN, RACH Douglas W. Soderdahl, MD, BAMC PDF VERSION: Saving Lives with SharePoint

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