BJC Healthcare and Washington University Barnes-Jewish Hospital: A Digital-Driven Group Hospital Model

It is not uncommon for hospitals to form groups to leverage each other’s strengths and pursue joint development. In the era of digital health, this “group-based” model takes on a new dimension. Digital health technologies enable hospitals within the group to break through geographical barriers and fully share high-quality resources, thereby accelerating their development.

BJC Healthcare is a typical example of “group-style” hospital systems in the digital health era. The following section examines its development trajectory, along with that of its prestigious affiliate institution, Barnes-Jewish Hospital of Washington University.

Merger History

Barnes-Jewish Hospital of Washington University can be described as both an old and a young hospital. It is considered old because it was formed by the merger of two long-established institutions: Barnes Hospital and St. Louis Jewish Hospital. Yet it is also young, as it is truly a “child of the 1990s,” having been officially established through its merger in 1996, making it just under 20 years old.

Barnes Hospital, founded in 1914, later became an affiliated hospital of Washington University. Throughout its development, the institution’s proudest achievements may well be its numerous outstanding contributions to medical advancement, such as the craniofacial reconstruction standards established by plastic surgeon Vilray Papin Blair and the world’s first pneumonectomy performed by thoracic surgeon Evarts Ambrose Graham.

Jewish Hospital of St. Louis was established earlier, having been founded in 1902. Five years later, it relocated to a new site just two blocks away from Barnes Hospital. The newly constructed hospital building featured advanced and well-designed facilities, earning it the Annual Modern Hospital Award presented by the American Hospital Association (AHA). Subsequently, in 1955, it began collaborating with Washington University School of Medicine, and in 1963, it officially became an affiliated hospital of Washington University.

Geographic proximity facilitated their initial collaboration. In 1993, Barnes Hospital, St. Louis Jewish Hospital, and Christian Health Services Community Hospital jointly established the BJC Health System (later renamed BJC Healthcare), a comprehensive healthcare system covering both urban and rural areas.

Three years later, in 1996, a major merger was officially finalized, combining Barnes Hospital and St. Louis Jewish Hospital to form Washington University Barnes-Jewish Hospital. The merged hospital experienced rapid growth. According to the latest data from BJC Healthcare, in 2014, Washington University Barnes-Jewish Hospital had 1,534 physicians, a total staff of 9,357, and a net profit of $1.7 billion. As of 2015, it had been listed among the “Best Hospitals” in the United States by U.S. News & World Report for 23 consecutive years. The entire BJC Healthcare system has also continued to expand. In 2014, the system employed 3,869 physicians and 26,514 staff members overall, with a net profit of $4.1 billion. Its member hospitals were distributed across various regions of Missouri, totaling 12 facilities (which increased to 14 by 2015).

Telemedicine—The “Group-Style” Hospital’s Key Tool for Breaking Down Barriers

Although BJC Healthcare’s member hospitals are relatively dispersed geographically, this does not mean that geographic constraints severely hinder mutual support among them. With continuous innovations in telemedicine technology, Barnes-Jewish Hospital of Washington University has been able to extend its medical services to member hospitals across Missouri and in neighboring states. Likewise, member hospitals have also leveraged telemedicine technologies to receive medical service support from other healthcare institutions.

The development of telemedicine systems at Barnes-Jewish Hospital, Washington University, began early. In the 1990s, Barnes-Jewish Hospital, Washington University, started installing telemedicine systems in various departments. By 1999, the system had covered multiple departments including emergency medicine, obstetrics and gynecology, and cardiology. The installed systems were fully utilized; besides being used for routine telemedicine services, they were also applied to remote teaching.

Currently, remote stroke treatment is one of the most well-developed components of the telemedicine system at Barnes-Jewish Hospital, Washington University. It has established a telemedicine network covering a 150-mile radius, integrating services such as remote diagnosis, remote treatment, and air ambulance transfers. The introduction of robots has played an indispensable role in the development of this remote stroke treatment network.

Before the introduction of telemedicine robots, physicians at Washington University’s Barnes-Jewish Hospital primarily provided remote guidance to clinicians at other healthcare facilities for the diagnosis and treatment of stroke patients via telephone. Following their implementation, physicians at Barnes-Jewish Hospital can now interact directly with stroke patients through the video conferencing systems integrated into the robots, thereby enabling faster and more accurate diagnoses.

▲The physician is using a robotic system to guide the patient through specific movements for diagnostic purposes.

Website — The Preferred Choice for Fostering Positive Doctor-Patient Relationships

Establishing a website is the preferred approach for nearly all healthcare institutions to foster positive doctor-patient relationships. BJC Healthcare is no exception, having developed official websites for each of its affiliated hospitals.

The official website of Barnes-Jewish Hospital at Washington University serves two primary purposes: first, to introduce the hospital’s various medical services; and second, to provide a search function that enables patients to find suitable physicians and schedule appointments directly from the search results page. There are two search options: searching by “Name” or by “Specialty.”

The figure below shows the search results for “Immunology” by specialty, obtained using the search engine on the official website of Barnes-Jewish Hospital at Washington University. The red circle on the left highlights the advanced search options, which include, from top to bottom: specialty, keywords, physician gender, languages spoken, practice location, accepted insurance plans, and patient age group. The blue circle in the center displays physician profiles along with quick appointment booking links. The yellow circle on the right features a Google Map marking the practice locations of all physicians returned in the search results.

Furthermore, it offers an e-library featuring a variety of easy-to-understand medical resources, presented in diverse formats including both text and video.

▲ Screenshot of a video on ear pressure from the online library of Barnes-Jewish Hospital, Washington University

For users who have purchased BJC Healthcare’s health plans, as well as any patients who have received care at BJC Healthcare-affiliated medical institutions, BJC Healthcare has established a dedicated portal, myBJC, to provide more convenient services.

Users can register at healthcare institutions that use myBJC or at hospitals under BJC Healthcare. Patients who have received medical care at BJC Healthcare-affiliated institutions within the past 30 days may also register independently. Upon successful registration, users can book doctor appointments, access health consultations, and utilize other services on myBJC. Additionally, through myHealthFolders, a sub-website of myBJC, users can view and manage their own and their family members’ medical information.

The information storage structure of myHealthFolders is illustrated in the figure below.

(Note: To protect privacy, a sample account was used to log in to myHealthFolders; all personal information shown in the images is fictitious.)

After logging in, you will enter the information management interface. The section circled in red displays the list of users under this account. Once authorized, additional user information can be added to this account for centralized management. The section circled in blue contains various types of information, which, from top to bottom, are personal information, service provider information, and medical history.

Select a user and open their personal profile. In the circled area of the figure, you can view the following items from top to bottom: General Personal Information, Number of Emergency Visits, Legal Information, and Reminder Services. Clicking on “General Personal Information” will display the relevant details on the right side of the screen.

The service provider's information consists of two parts, listed from top to bottom: the medical service provider and the insurer.

The information in the medical history is categorized in great detail, including personal medical history, family medical history, drug allergies, and other sections.

In addition to managing their medical information online, myHealthFolders users also receive a physical emergency card. The card records the holder’s critical medical information, such as drug allergies and medical history, for reference by emergency responders. When necessary, after identity verification, emergency personnel can use the emergency card to log into the holder’s myHealthFolders account to access relevant data.

Home Monitoring Program

Since the establishment of Barnes-Jewish Hospital at Washington University in 1996, a home monitoring program has been introduced. This service has consistently received positive feedback from users since its launch. However, due to a lack of home remote monitoring devices and limited medical staff, BJC Healthcare has been unable to provide 24/7 uninterrupted monitoring services to every user in need. To address this gap, BJC Healthcare organized a team to develop a remote monitoring system, HomMed Telemonitoring, and a remote monitoring device, Lifeline with AutoAlert.

The core component of the HomMed Telemonitoring System is the HomMed monitor. HomMed provides scheduled daily reminders for users to perform tests, collects vital sign data such as blood pressure and blood glucose levels, and transmits this data to the BJC Home Monitoring Center, where dedicated healthcare professionals analyze it. The HomMed device also evaluates the data independently; if any readings deviate from normal ranges, it immediately notifies physicians to investigate potential risks.

Lifeline with AutoAlert is specifically designed for patients who are immobilized or unconscious after a fall. It consists of two components: a sensor and a communicator.

The sensor is waterproof and can be worn around the clock as a necklace or bracelet to detect whether the wearer has fallen. If the wearer fails to get up within 30 seconds after a fall, the sensor sends a signal to the call device. Upon receiving the signal, the call device immediately notifies the BJC Home Monitoring Center to dispatch personnel for rescue. Currently, the call device can receive signals from the sensor within the range of a typical home environment.

App—Beyond “Becoming a User,” Participation from Healthcare Service Providers Is Also Required

In the United States, there are numerous healthcare-related apps. Statistics show that by 2014, their number had already exceeded 40,000. However, only a small fraction of these apps truly assist physicians and patients. One contributing factor to this phenomenon is the insufficient involvement of healthcare providers in app development.

Graham Colditz recognized early on the importance of involving healthcare professionals in app development. As the Associate Director of the Division of Cancer Control and Prevention at the Siteman Cancer Center, Barnes-Jewish Hospital, Washington University, he personally led a team in 2012 to develop Zuum, an app for assessing the risk of common diseases. The team included Hank Dart, Public Health Communication Advisor at the Siteman Cancer Center, and Heather Corcoran, Associate Professor at the Sam Fox School of Design & Visual Arts, Washington University.

Zuum integrates Graham Colditz’s pioneering research conducted in 1976 and 1996. It rapidly assesses an individual’s risk of developing heart disease, diabetes, stroke, and various cancers—including lung and breast cancer—and provides personalized recommendations based on lifestyle habits to guide users toward a healthier life.

▲Zuum's User Interface

Although Zuum has been successfully developed and is highly recommended by many users, like most medical apps, it targets general users rather than professional physicians. Why didn’t Graham Colditz leverage this experience to design an app specifically for doctors? Graham Colditz explained that electronic health records (EHRs) have advanced rapidly in recent years, completely replacing apps in certain functionalities. Additionally, physicians tend to prefer using computers over smartphones or tablets during their work hours, resulting in slow growth in app adoption among doctors.

Electronic Medical Record

As Graham Colditz’s response indicates, the capabilities of electronic health records (EHRs) have been progressively enhanced, and physicians have shifted from initial discomfort to increasing reliance on these systems. Since the passage of the American Recovery and Reinvestment Act in 2009, the $20 billion in stimulus funding allocated has indeed promoted the development of EHRs in the United States. Their value has become increasingly evident with this advancement: hospital operational efficiency has improved significantly, leading to a corresponding reduction in expenditures. According to projections based on 2006 data from Brigham and Women’s Hospital, EHRs could save the national healthcare system up to $16.7 billion over a ten-year period.

The value of electronic medical records (EMRs), coupled with the lag in technical support compared to competitors, compelled BJC Healthcare to accelerate its development efforts in 2010. At that time, BJC Healthcare made substantial investments to implement EMR systems at Washington University’s Barnes-Jewish Hospital and eight other affiliated hospitals. In September of that year, it overhauled the existing online medication ordering system at Barnes-Jewish Hospital and introduced barcode systems across its hospitals to further enhance the accuracy of medication dispensing.

By March 2014, BJC Healthcare had begun engaging with Epic, the largest electronic health record (EHR) vendor in the United States, to discuss a potential partnership. After 12 months of negotiations and evaluation, a contract was signed in March 2015. Over the coming period, Epic will assist BJC Healthcare’s affiliated medical institutions in building a comprehensive, unified EHR storage system. Implementation of this system commenced during the negotiation phase; consequently, myBJC users can already access their electronic health records through myHealthFolders.

A major feature of digital health technologies is their ability to transcend geographical barriers, an advantage that can help healthcare organizations pursuing a “group-based” development model overcome the disadvantages of geographic dispersion. The case of BJC Healthcare, centered around Barnes-Jewish Hospital affiliated with Washington University, demonstrates the significant benefits it has derived from digital health technologies. In the future, digital health technologies are certain to deliver even greater value to BJC Healthcare.

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Text | Zi Junwei