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Creating the Digital Hospital

May 1, 2006
by Robert Mockler, M.D., and Dorothy Dologite
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A number of hospitals are taking steps down the road to automation.

Digital hospitals promise to dramatically improve patient healthcare services.

By creating the digital hospital, a number of hospitals in this country are leading the way in developing and using information systems to solve industry problems that include those inherent to manual recordkeeping. Errors resulting from incomplete, misplaced or illegible records, among other problems, are estimated to have killed over 7,000 U.S. hospital patients yearly and drive up healthcare costs by an estimated $2 billion.

The difficulty in coordinating and integrating diverse customer interactions in a way that makes each individual feel special and enables coordination of services to these individuals is a huge challenge. In addition, hospitals must be able to facilitate communication among their many ancillary departments and schedule and manage staff members' time.

Tracking billable supplies, as well as caregivers' time, is necessary for accurate billing and, preferably, is integrated across the enterprise. Interestingly, many hospitals do not even have an integrated billing system for patients, who receive separate bills for different department services and room accommodations, creating much confusion among patients and health plans.

Based on hospital experiences with IT development, the starting point almost always involves building accessible, integrated patient-centric databases. The most significant applications of such databases are in prescription writing and delivery and in the intensive care unit (ICU).

Cases in point

Probably the most visible evidence of the new digital systems at the Children's Hospital in Pittsburgh is the trolley. Wheeling the mobile wireless laptop computer to the bedside, physicians log into the clinical information on each of their patients. They order medication online and send these orders from the seventh floor ward to the pharmacy in the basement, where a robot puts the prescribed drugs in an envelope for the nurses to dispense.Robert mockler, m.d.Dorothy dologite

All of this is made possible by the electronic patient database. This laptop-enabled system significantly reduced the major problems encountered from medication errors under the old paper-based system.

Another type of benefit is found in the management and running of ICUs. An IT-based ICU system in which one doctor and nurse can keep a 24-hour watch over as many as 200 critically ill patients at once can boost chronically short-staffed onsite care. In addition, studies have reported as much as a 50 percent drop in ICU mortality and 17 percent shorter stays since the first such system was set up at Hampton Roads, Va.'s Sentara Healthcare a few years ago.

Like the telemedicine use in ICUs, the U.S. military in Iraq has used the technology to set up a field hospital unit connected by computer systems to a well-staffed hospital unit located elsewhere.

Using the technology for education, Kapiolani Medical Center for Women & Children in Hawaii broadcasts surgeries to physicians around the world in real time. This allows specialists worldwide to observe and consult with Kapiolani surgeons during emergency and other procedures and provides invaluable educational outreach programs.

After implementing an integrated clinical information system (CIS) to provide clinical decision support tools including Siemens Medical Solutions (Invision), Cincinnati Children's Hospital Center, for example, won the 2003 Nicholas E. Davies EMR (Electronic Medical Record) Recognition Award of Excellence. The results were elimination of transcription errors, a 50 percent reduction in medication errors, a 52 percent improvement in medication turnaround times, a 24 percent reduction in verbal orders for controlled substances, and 100 percent compliance with pain assessment documentation requirements defined by state regulatory agencies.

Bumps in the road

Although substantial gains from introducing and using medical IT systems are documented, major problems have been encountered. For example, outside physicians at many hospitals have resisted — and in some instances even scuttled — new medical IT systems. It is far easier to use a pen to write a prescription order or tell a nurse what to do than it is to have to learn a whole new system, no matter how fast or easy it may eventually be to use. A second key problem area is cost.

... outside physicians at many hospitals have resisted — and in some instances even scuttled — new medical IT systems.

On the other hand, support can smooth many of those bumps. Massachusetts healthcare providers are on the leading edge of healthcare IT implementations. One factor is the state's backing and financial support.

In almost all instances, available finances will have an impact on the nature and pace of medical IT systems development, as will the leadership skills of hospital managers in overcoming resistance to change encountered at almost all operational levels.

Author Information:

Robert Mockler, M.D., is Joseph F. Adams Professor of Management at Tobin College of Business — Graduate Division, St. John's University.