No area of clinical care in hospitals is a bigger revenue generator than the surgical area, and few are more critical in terms of patient safety and clinician efficiency issues. But the unique clinical care processes, scheduling issues, data needs, and other challenges in the operating room make developing IT solutions for surgery uniquely difficult.
That's why, in the OR more than anywhere else in the hospital, the tension between core clinical-vendor and best-of-breed clinical IT strategies is felt most acutely. So, while clinician, IT and financial leaders all agree that the OR needs to be automated as much as possible, OR professionals remain divided on exactly how.
What is clear is that progress is being made, spurred on by the need for greater operational efficiency, surgery-case throughput, and accountability for clinical outcomes, says Marion McCall, R.N., a clinical specialist in perioperative informatics at Barrington, Ill.-based GE Healthcare Integrated Information Technologies.
McCall, chair of the Perioperative Nursing Informatics Specialty Assembly of the Denver-based Association of periOperative Registered Nurses (AORN), says, according to AORN's most recent study, "Somewhere between 85 percent and 90 percent of hospitals have some type of partial automation for their ORs. Scheduling and doctors' preference cards are being automated first, and nursing documentation is coming next."
Integration of anesthesia documentation and materials management information integration still lag behind, with both somewhere around 10-15 percent implementation nationwide, she adds.
Among the hospitals moving forward using IT to optimize perioperative care delivery is 308-bed St. Alexius Medical Center in Bismarck, N.D. St. Alexius implemented a new, updated clinical documentation system in its OR in February 2004, and patient safety, care quality, and clinician efficiency have all improved since then, says Tammy Escontrias, R.N., assistant director, surgical services.
"The documentation piece for the OR R.N.s is much quicker than it was in the past," Escontrias reports. "Coming up with the preoperative diagnoses as far as what the patient needs, and having a care plan to follow, have been improved in terms of their processes. But the biggest thing that's changed is in the data-collection area."
Clinical utilization reviews, reviews of surgeon cases and surgeon minutes, surgeon credentialing, and equipment tracking are processes that have been improved through expanded automation, she says. (Escontrias and her colleagues use the OR solution from Wakefield, Mass.-based Picis.)
What Escontrias and her colleagues believe firmly is that only an OR-specific solution could do all this. As Rick Seiler, the hospital's operations coordinator for clinical services, puts it, "I support the best-of-breed approach, and I know our CIO does as well." From his perspective, core clinical vendors don't have the advanced, OR-specific capabilities needed to optimize perioperative, surgical, and post-surgical processes.
Others aren't so sure. "It's always the issue of balancing the ultimate with what's realistic," says James Witt, R.N., system vice president, clinical integration, at Mokena, Ill.-based six-hospital Provena Health system. "There are always trade-offs. And OR systems are the classic case of trading capabilities for integration. We always ask ourselves, when it comes to a specialty product, what is the trade off? And in many cases, we found the investment in interfacing is too high."
Witt and his colleagues at Provena say they have made significant quality and efficiency inroads relying on the surgical component of their core clinical system product (from Westwood, Mass.-based Meditech).
Of course, as OR nurses raise their voices to be heard, the dynamics of OR solution purchase may change. "One thing I hear almost every time I'm in front of nurses," McCall says, "is that systems are implemented to meet the needs of the IT department, rather than by looking at the needs of the person who has to spend the most time with the patient" — the nurses. As nurses increasingly demand to be heard, she predicts vendor choices will change.
Mark Hagland is a contributing writer based in Chicago.