One healthcare analyst calls hospitals "one of the last great bastions of techno-ignorance." Former House speaker Newt Gingrich, speaking about medical errors, put it another way: "Paper kills. It is immoral for us to keep using paper records."
Experts believe thousands of deaths from medical errors can be prevented by new information technologies. Says Kenneth Kizer, president of National Quality Forum, "The potential to use information technology to dramatically improve healthcare is enormous."
Some Washington-area hospitals are moving into the digital age. "The more computerized we become, the better off we're going to be because it will reduce human error," says Suburban Hospital CEO Brian Gragnolati. "But it will take time because we must change the hospital culture so the staff will accept and use this new technology, and it's very expensive."
In time, these technologies will change the way hospitals deliver care, reduce errors, and save money. Dr. David J. Brailer, the Bush administration's healthcare-technology expert, says that tech investments could save $140 billion a year by 2014.
Here are key advances in medical-information technologies:
Patient Records Come Into the 21st Century
Last fall the obstetrics department at Georgetown University Hospital began using a computerized medical chart called Intelligent Patient Record, or IPR. All patient data formerly written by hand are now entered electronically. "This makes everything on the patient chart legible," says Dr. Helain J. Landy, chair of obstetrics at Georgetown, "and that's not a small thing."
The computerized records also make a patient's drug allergies, diagnoses, treatments, lab results, and medical history available at computer stations in the hospital's delivery area. The IPR comes with software that can warn about potential adverse drug interactions and overmedication. Electronic records also can be used to track an individual physician's prescribing patterns, lab and x-ray use, and patient outcomes.
Georgetown and Washington Hospital Center, which also has IPR, plan to extend the technology into prenatal care, and Inova hospitals are increasingly putting patient information into electronic records.
Electronic medical charts should reduce errors that occur when a patient is transferred from one floor or specialist to another, and medical records can be put on a memory chip or computer disc that patients can carry. Electronic records facilitate the collection and analysis of patient data and therefore should lead to more reliable hospital evaluations.
Extra Eyes and Ears in the ICU
On the second floor of the Verizon building in Falls Church, Susan Rogers, a nurse with 18 years of intensive-care experience, scans a bank of computers that monitor ICU patients in Inova hospitals miles away. The electronic ICU, or eICU, was developed by intensive-care specialists at Johns Hopkins. So far, the Inova Health Care System is the only one in the area to have it.
Inova's eICU, which cost more than $2 million, covers 132 ICU beds in Inova's four Northern Virginia hospitals–Fairfax, Fair Oaks, Alexandria, and Mount Vernon–and will be installed in the recently acquired Loudoun Hospital Center next year.
"We're not replacing anything or anyone with eICU," says Terry Davis, its patient-care director. "We are an extra set of eyes and ears to help our floor nurses and provide an additional safety net for patients. We still have the same 2-to-1 ratio of patients to ICU nurses as we did before."
Davis says the eICU has prevented "countless" potentially serious incidents. It helps get care to ICU patients faster, provides real-time readouts of patients' vital signs, shows patient trends, and warns of abrupt changes in a patient's condition. When there is an alert, the eICU nurse can activate a video camera in every the room to observe the patient. The lens can zoom in tight enough to read a bedside chart.
At night, when there are fewer doctors in hospitals, an intensive-care specialist, or intensivist, is on duty at eICU headquarters to make medical decisions.
Computerized Rx for Medications
From the time a physician prescribes a medication for a hospital patient to the administration of the drug, there are anywhere from 40 to 70 steps. Little wonder that medication errors are the most common hospital mistake.
Computerized Physician Order Entry (CPOE), sometimes called e-prescribing, uses technology similar to supermarket bar codes. When a doctor prescribes a medication, it is entered into a computer and transmitted to the hospital pharmacy, where the medicine is prepared and bar coded. At the patient's bedside–where 38 percent of medication errors occur–the bar code is matched to the bar code placed on the patient's ID wristband on admission. This ensures that the patient gets the correct medication in the correct dosage. CPOE also alerts staff to a patient's drug allergies or potentially adverse drug interactions, the leading cause of preventable harm for patients.
The Walter Reed Army Medical Center (which the Defense Department wants to close) and the Veterans Affairs Medical Center are the only area hospitals with full CPOE systems. Four area Inova hospitals have CPOE in their ICUs; Inova is putting it in Loudoun and into all if its emergency rooms.
George Washington University Hospital has CPOE in its emergency department and is developing a system for its in-patient units. Montgomery General Hospital is implementing bar coding and says it will have a full CPOE system in place within a year, as will Shady Grove Adventist.
Sibley will begin bar coding in 2006 and plans to have CPOE soon after. Suburban Hospital says its CPOE system should be running within a year, and Howard University Hospital's partial one, in its emergency room, is already in use.
The cost of CPOE is formidable–about $8 million for a hospital of 500 beds, plus up to a million dollars a year to operate and maintain. But studies show CPOE would avert at least 570,000 serious hospital medication errors each year–or up to 90 percent of such mistakes.
CPOE is not foolproof–studies at two hospital systems fouind more errors than expected. But advocates say written prescription errors are still far more prevalent and much less correctable.