ZIFFPAGE TITLECrawling Toward Digital ConversionBy Kim S. Nash | Posted 2005-05-04 Print
This "digital hospital" has likely paid for itself in less than two years. And it's radically cutting the time it takes to treat a heart attack.
Crawling Toward Digital Conversion
Many hospitals and clinics across the country have some electronic records. Yet less than one-third of emergency and outpatient departments have computerized health records, according to the Centers for Disease Control. Just 8% of doctors order medications or tests electronically, the CDC says.
Even fewer health-care outlets have taken Indiana Heart's path and redone the entire clinical workflow in ones and zeros from admission to discharge, from physician progress reports to lab test results. There's St. Francis Heart Hospital, a new $50 million facility that opened in Tulsa, Okla., in September 2004. In late 2003, St. Vincent Hospital in Birmingham, Ala., completed a $45 million project to retrofit the 107-year-old facility with information technology throughout. And in March, The Mayo Clinic in Rochester, Minn., switched from paper to electronic patient charts, in a project with IBM.
HealthSouth Corp.had planned to open a $125 million digital hospital in 2003. The company, however, was the target of a federal investigation into alleged accounting misdeeds. And the hospital, which is only partially built and reportedly $70 million over budget, is now up for sale.
That makes Indiana Heart one of the most closely watched all-digital facilities, after just two years. Before opening, it spent $15 million, or 23% of its $65 million startup costs, on technology. The hospital now spends about $500,000 a year with GE, for maintenance and development. Still, increased efficiencies mean the hospital's information technology has probably already paid for itself, according to Baseline estimates (see chart, at right).
Along with Centricity, which runs across 60 Compaq servers with the Microsoft Windows NT operating system, Indiana Heart offers clinicians 400 to 600 Compaq laptops and personal computers, some with Elo TouchSystem touch-screen monitors, to access data. Computers aren't quite as prevalent as pens and pencils, but the goal is data access anywhere a caregiver needs it, Veillette says.
A Compaq computer sits next to the bed in each of the 88 rooms. About 50 handheld devices from Symbol Technologies and Samsung are available for doctors to take on rounds. More than 100 wireless bar-code scanners from Metrologic Instruments track medications.
The technology infrastructure also includes medical devices that generate information, such as IV pumps that regulate medication intake and arm cuffs that monitor vital signs. Such data goes right into the patient's electronic chart. The wireless and wired networks are built on Cisco Systems equipment.
In a traditional hospital, a patient chart is a collection of notes and forms pierced with a three-hole punch, clipped into a plastic binder and stored on bookshelves at the nurses' station.
Centricity replaces that. A nurse tending to a patient signs on to the system at a computer next to the patient's bed. She clicks through the Nursing Bedside Documentation module, which looks like a spreadsheet, to record how the patient is doing. For example, she assesses patient state from zero (unresponsive) to three (calm and cooperative) to six (dangerously agitated and uncooperative). She verifies temperature, heart rate and other vital signs that have been sent to the chart automatically from a monitor attached to the patient.
Clicking a mouse to check a box completes some tasks, such as vital-sign verification. Others are pick lists, such as the patient's state.
She signs off when she's done, then enters the next patient's room and signs on to update his chart.
When a doctor comes by on rounds, he signs on to record his evaluation and progress notes. Blood-test or X-ray orders get typed in and are automatically routed to the appropriate laboratory and placed in a job queue there. Medication orders are similarly routed to the pharmacy for fulfillment.
This is a sea change for doctors used to scribbling notes in a chart and walking away, and not all of them like it, says Mark Heithoff, I.T. site director.
Though writing notes on paper takes only one-eighth the time of typing and clicking them at a keyboard, using computers speeds the rest of the patient care process. Beyond the problems caused by the infamous illegibility of physician handwriting, routines that depend on paper have inherent treatment delays. After the doctor leaves the floor, a nurse must find the chart, read through the orders, then call the labs to order tests and the pharmacy to order drugs.
If she has questions, the whole process stops while she tracks down the doctor. It may take hours, Heithoff says. With a digital chart, it takes seconds, he explains, so "you gain immediacy and clarity."
Still, Centricity is a work in progress.
For example, when the system was first installed, it took 40 seconds for a nurse to sign on. Software developers at GE in Waukesha, Wisc., thought that was OK, and for some business applications it would be, Heithoff says. "But we had them shadow nurses and do it as a nurse wouldhundreds of times a day," he says. "Now it's under 10 seconds."
At Indiana Heart, nurses update charts by lingering at computers in or just outside rooms. One surprise byproduct is a 50% decrease in patients falling when they try to walk too soon. Forty-three cardiac patients fell at Community Health Network in 2002. At Indiana Heart, 22 fell in 2003.
"Nurses are just there more at the bedside to interact and help," Veillette says.
So far, the metrics suggest that when the work of doctors, nurses, lab technicians, pharmacists and other clinicians isn't jammed up by a paper chart, they get to patients faster. They recognize infections or adverse reactions sooner. They administer urgent treatments such as balloons to open clogged arteries more quickly, whether to a patient recovering from surgery or to someone rushed off an ambulance in the middle of the night.
"Our hospital's sustainable competitive advantage is not the digital chart," Heithoff declares. "It's people who improve patient care."
SOURCE: Indiana Heart Hospital
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