Giving Health Care a Dose of IT
Hospitals, medical clinics and doctors in private practice have long discussed the need to improve health care with information technology—such as computerizing patient records—but few have done it because of the cost and complexity. The Fallon Clinic in Massachusetts is among those taking action and making the vision of high-tech medicine a reality.
In 2005, the Fallon Clinic, which has more than 20 medical facilities in the Worcester area, began migrating from a 12-year-old custom-built electronic medical record system to a more fully featured EMR application, which offers e-prescription, and a clinical decision-support system that provides physicians with best practices for care. It can, for example, warn doctors if prescribed drugs could result in adverse reactions.
One doctor credits the new EMR software with helping him detect prostate cancer early for several patients. He took several years of blood tests, and with a few keystrokes, created a chart from the raw data, and discovered that while the results were within the normal range, they were going up—a sign the patients could be at higher risk for developing cancer.
“We caught the cancer early using the EMR,” says Dr. Larry Garber, the Fallon Clinic’s medical director for informatics. “We could see what was happening over time, something we couldn’t do properly prior to the system. It’s allowed me to provide patients with better care and avoid making mistakes.”
The health care industry has been slow to adopt electronic health records and other new IT initiatives because of costs and the uncertainty about return on investment. But that’s starting to change as early adopters achieve results. These technologies streamline health care operations, reduce medical errors, and give doctors and nurses timely access to patient information, resulting in more cost-effective and vastly improved patient care.
Today, 13 percent of physicians use basic EMRs to store clinical notes, order prescriptions, and view lab and imaging results. Only 4 percent have fully functional systems that include clinical decision-support systems, according to a 2008 study by the New England Journal of Medicine. Adoption is on the rise, however: Sixteen percent have purchased EMR systems but have yet to install them; another 26 percent plan to buy a system in two years.
Provision of electronic health records is just one piece of the health care IT puzzle, but it’s an important one because it drives related IT initiatives, such as mobilizing the work force with wireless devices and digitizing paper processes into an electronic workflow, says Barry Runyon, a health care analyst for Gartner, a research firm in Stamford, Conn. Cutting-edge health care providers have begun to develop portals, giving their patients the ability to pay their bills, schedule appointments, view lab results and even consult with their doctors online.
ROI of EMRs
The Beth Israel Deaconess Medical Center in Boston custom-built its online medical record application in 1985. It then developed a Web version in 2002 to give its hospital physicians the flexibility to use any computing device—including a notebook computer or a smartphone—to check their schedules, messages and patient data.
“Everything we do is browser-based and operating system neutral,” says Dr. John Halamka, the medical center’s CIO. “Doctors are mobile, and it’s key that they can use client devices while they’re on the road, at home or at the hospital.”
More recently, Beth Israel invested $8 million to build a hosting facility that will allow its 300 affiliated private practices to use EMRs as hosted applications. The hospital is subsidizing 85 percent of the costs, so the hospital and its affiliated doctors can coordinate care and improve patient care and safety, Halamka says.
Beth Israel’s pay-for-performance contracts with its health insurers require the hospital and clinicians to act as an integrated community and to report performance as a group. Moving everyone to a homogenous EMR allows the hospital to do that. “With an electronic health record, the primary care physician can send it to the next provider, so care is coordinated,” Halamka says. “It’s about providing quality health care, reducing redundant testing and making sure all doctors know what medicines a patient is taking.”
To build the hosting facility, Halamka standardized on eClinicalWorks’ medical software running on Hewlett-Packard servers connected to an EMC storage area network (SAN) that holds up to 11.1 terabytes (TB) of storage. To better utilize servers, the IT staff is using VMware software to virtualize servers. Each doctor’s office will be given its own virtual server to house and access its EMRs.
The Beth Israel IT staff is implementing the EMR system at eight practices per month and should finish the project by 2010. Each private practice will pay $6,000 for software and $9,000 for hardware. Without the subsidy, each practice would have had to spend between $40,000 and $60,000, and most would not have been able to afford it, Halamka says.
The Fallon Clinic also invested heavily in technology: It spent $24 million over three years to migrate its clinics to the new EMRs. Prior to the upgrade, the clinic stored most of its patient data in electronic format, but it still used paper charts when the staff saw patients. When the clinic began implementing the new EMR software from Epic Systems in 2005, staffers scanned in the remaining paper documents and then rolled out the technology in phases.
Initially, the IT staff implemented the basic functions, allowing doctors to access patient test results and clinical notes in read-only format. Then they rolled out e-prescriptions. Next, IT installed desktop computers and monitors in each exam room, allowing physicians to show patients their test results. After that, IT implemented all the EMR features, where everything is done on the computers. “We separated each phase by six to eight months to allow the physicians to become proficient and comfortable with their skills,” Garber says.
The Fallon Clinic’s data center has 40 servers on a Citrix farm that supports 1,550 Epic software users. A SAN stores 15TB of clinical data, X-rays and other images. The servers are mirrored, so if one goes down, it fails over to another server.
The EMR technology helps the clinic save money in two ways: First, the electronic workflow is more efficient, so the clinic no longer pays its staffers to process paper. Second, it has saved millions of dollars by using speech- recognition software to replace outside transcription services. Doctors use Nuance Communication’s Dragon Medical Software to dictate to their computers, and the software translates it into text. By eliminating transcription costs and paper shuffling, Garber estimates that the system will pay for itself in five to six years. Beth Israel, which uses Nuance’s eScription software, has saved $5 million in transcription costs since 2002.
Wireless and Mobile
Though EMR technology is growing in importance, other technologies are starting to play a role in the health care industry. For instance, Island Hospital in Anacortes, Wash., has gone wireless. Nurses carry tablet computers as they make their rounds, recording temperatures, blood pressures and heart rates directly into their patients’ EMRs.
Staffers also wear wireless voice over IP devices to talk to one another. These devices from Vocera are about the size of a pack of gum. To reach a colleague, an employee presses a button and says the name of that person. On the receiving end, the employee is told who is calling and is asked whether he or she wants to answer the call.
“It’s good for locating people,” says Rick Kiser, Island Hospital’s assistant director of information systems. “Nurses who need assistance no longer have to run into the hallway to call another nurse.”
In addition to these technologies, the hospital invested in a new imaging system, applications and servers. It also upgraded its Fast Ethernet LAN with Gigabit Ethernet D-Link switches and uses Cisco equipment for its Wi-Fi network.
Both the wireless communications and computing devices have made hospital staffers more productive and efficient.
About four years ago, the IT staff equipped its nurses with computers on wheels, but the devices were big, unwieldy and hard to keep clean—and there weren’t enough of them. Last year, IT purchased 3-pound Motion Computing C5 tablets, each of which includes a handle for easy carrying, a 10.4-inch screen, a stylus pen and a tough exterior that protects it from spills and drops. The tablets also include built-in scanners—for checking the barcode ID on patients and their drug prescriptions—so nurses can make sure they are dispensing the right medicine to patients.
The St. Vincent’s Health System in Alabama moved from paper records to EMRs 15 years ago, but hospital administrators recently decided it was time to replace its remaining paper-based systems (the patient registration process and many human resources forms) with an electronic workflow.
The health system, with four hospitals, is using Adobe Systems’ LiveCycle software to create and manage new electronic documents. This spring, the IT staff will pilot an electronic hospital registration system, whereby incoming patients will sign consent forms and Health Insurance Portability and Accountability Act release forms electronically.
St. Vincent’s IT staff will test several technologies, including a Wacom monitor, which is a tablet-like computer device, and a signature scanner, which is similar to signing a credit card at the store, says Steve Anderson, director of IT. Today, the hospital has to scan in a patient’s paper records at the end of the hospital stay at a cost of 6 cents or 7 cents a page, so an electronic registration process will save money.
St. Vincent’s management believes it has built the foundation for a future portal by allowing its patients to pay their bills online. It hopes to develop that portal within two years and include online consultations for minor health issues via e-mail or instant messaging, Anderson says.
Health care IT initiatives—ranging from EMRs to patient portals—improve patient care, but they also help the bottom line by improving operational efficiencies and attracting and retaining customers, says Garber of the Fallon Clinic. “If we can’t stay financially solvent, we’re gone,” he says. “EMRs make us more efficient, which saves us money and enables us to provide higher quality medical care. Attracting more patients keeps us in business.”