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Digital Hospitals Aim to Document Better Outcomes

April 14, 2008
Digital hospitals aim to document better outcomes The type of data analysis required to significantly improve patient care can only happen in a digital platform Apr 1, 2008 By:Ken Krizner Managed Healthcare Executive TECHNOLOGY HAS BEEN A PART of the hospital landscape for decades, and hospitals have now begun to implement digital technology to improve communications between physician and nurses, lessen the likelihood of medication errors, and improve the quality of care, leading to better patient outcomes. Some are investing as much as 25% of their budgets to become digital. "There is some form of technology in virtually every hospital in the country," says John Vitalis, a senior principal for the Noblis Center for Health Innovation, a Falls Church, Va.-based nonprofit technology organization. "It touches every department, both clinical and non-clinical." A digital hospital transformation often includes making patient data immediately accessible to any pertinent clinician within the facility or in a remote location. Many new hospitals are building in all-digital platforms, and older hospitals are increasingly switching over. HHS estimates that health IT could save as much as $140 billion a year by 2014. MHE EXECUTIVE VIEW "With an electronic chart, you can have things going on concurrently and simultaneously," says David Pecoraro, vice president and chief information officer for Exempla Healthcare, a three-hospital, 1,000-bed system in Denver. "The attending physician, specialist and nurse can all have the chart open at one time. All patient data goes to a common record." Older hospitals are finding money in their capital budgets to transform themselves into digital facilities one step at a time, perhaps starting with the implementation of a computerized physician order entry (CPOE) system, followed by electronic medical records (EMRs) and the adoption of clinical systems for the emergency department. While the cost for implementation varies, Vitalis says it is not unusual for hospitals to allocate between 20% and 25% of their capital budgets for digital technology. DATA STAYS WITH THE PATIENT The use of an integrated system allows providers to track many patients quickly, such as when a patient is transferred out of a critical care unit. "With our paper-based system, very little of a patient's data in the critical care setting was available to the general care attending physician," says Lee Carmen, chief information officer and associate vice president for medical affairs for University of Iowa Health Care, which began implementing a third-party technology solution in January 2007. "They were unable to see the history of that patient, whether there was an incidence of cardiac arrest or what medications were administered." Now, all information is electronically stored and stays with that patient from the critical care setting to general care to discharge to primary care. On a real-time basis, the technology allows physicians and nurses to focus on patient care, rather than on constantly updating chart information, Carmen says. On an analytical basis, digital technology allows clinicians to conduct post-treatment reviews in a way that was almost impossible in a paper-based system. "We are able to collect, aggregate and study the data along particular diagnosis-related groups or service lines," Carmen says. "We're analyzing what treatment protocols yield what clinical outcome successes over a substantial patient population and period of time. This is truly transforming and absolutely crucial to our success. This type of analysis cannot take place without a high degree of digitalization." DIGITAL FROM THE BEGINNING University of Iowa Health Care has used some form of IT on its clinical side for decades, going from its own in-house solution to commercial, off-the-shelf solutions to the current third-party integrated system. That led to some problems over the years, including disparate systems that were unable to communicate with each other, Carmen says. Dublin Methodist Hospital in Dublin, Ohio, and Exempla Good Samaritan Medical Center in suburban Denver, however, are two new-build facilities that were constructed with integrated clinical digital technology solutions in place. "We had a guiding principle that we wanted to be digital, wireless and paperless to the maximum extent possible," says Cheryl Herbert, president of Dublin Methodist Hospital, part of OhioHealth, an eight-hospital system. Dublin Methodist, which opened in January, implemented a wide range of third-party technology products that work together. Integration from the ground up improves the quality of patient care, Herbert says. "If we have a patient not doing well overnight, the attending physician can pull up a patient's record [remotely], review the current vital signs, and see what tests have been performed and the results," she says. "The physician can advise the nurse on how to proceed. It makes care that much more efficient." Exempla Good Samaritan opened in 2004 with the same take on digital, says Exempla Healthcare's Pecoraro. The facility is fully automated with CPOE and clinical documentation, while its sister hospitals, Exempla St. Joseph and Exempla Lutheran, each have a sophisticated emergency department automated system. The Picis emergency department system includes all aspects of registering and triaging a patient, and it includes CPOE and discharge instructions to either the general care unit or to the patient's family physician. For patient satisfaction, Pecoraro says automation in the emergency department is vital. "In many ways, the emergency department is the front door to your hospital," he says. "The efficient and effective care of those patients at the time of arrival is important. You want to take advantage of everything you've done in the ER and not repeat unnecessary tests." Pecoraro estimates that there will be a 20% to 30% reduction in a patient's time in the emergency department because the technology will allow for more efficient processing. "We also think there will be better consistency in the care we provide," he says. "The system is sophisticated enough to prompt physicians with risk alerts." IMPROVING QUALITY OF CARE This type of technology in the hands of clinicians will improve patient outcomes, reduce medication errors and lower the cost of a hospital stay. University of Iowa's Carmen says the use of digital technology to study treatment protocols will allow the hospital to create clinical guidelines that will further improve outcomes in the future. While Dublin Methodist has no data as of yet, Herbert is convinced that digital technology will reduce medical errors. "Technology has allowed us to create a closed-loop medication system where the process is fully automated, from the time the medication is delivered from the supplier until the medication is delivered to the patient," she says. "We track our medication through the entire process with technology." These and other benefits resulting from the implementation of digital technology will lead to lower hospital costs. Ken Krizner is a Cleveland-based freelance writer.