Connor, Deni; Mears, Jennifer

July 15, 2003

Originally Published:20030707.

For IT executives in large healthcare organizations, compliance with the Health Insurance Portability and Accountability Act is, surprisingly enough, last year's business. With HIPAA under control, IT executives are turning to a more pressing issue: how to improve patient care on a tight budget.

Jeff Pelot, CTO for 350-bed Denver Health (formerly known as Denver General), has an astounding 120 projects underway. "My biggest challenge is keeping up with what we are doing," he says. Pelot's priorities are creating Web-based access to imaged medical records, providing high-speed access to the medical records department so employees can work from home, and updating his Oracle server back end.

Denver Health has invested 8% to 9% of its budget in IT, which has become "a very strategic part of the organization," Pelot says. IDC says that most healthcare organizations only spend about 2% of their budgets on IT, while the average across other industries is about 5%.

Even though Pelot has a higher percentage of his company's budget allocated for IT than most healthcare providers in the U.S, he still can't implement everything he wants. A voice recognition project recently was delayed because of lack of funding.

Jocelyn Young, an analyst at IDC, says that healthcare organizations tend to invest in areas that will help their mission, which is providing patient care. And technology is one of the key enablers of improved healthcare, she adds.

A Modern Healthcare study conducted by PricewaterhouseCoopers and R. Marreal and Associates reinforces this. It concludes that improving patient-care capabilities through IT is the No. 1 priority of 63% of the CEOs, CFOs and CIOs who responded.

In Network World interviews with more than 20 IT executives in healthcare, the top two projects were electronic medical records (EMR) and computerized physician order entry systems (CPOE), plus installing and fostering the use of wireless tablets and handheld PCs.

Mark Moroses, senior director of technical services and security officer at Maimonides Medical Center in New York City, is trying to improve patient care by upgrading his electronic medical record system, despite facing budget cuts.

"We were affected by the proposed Pataki cuts [in Medicare and Medicaid reimbursements], and we are starting a five-year renovation process," Moroses says, referring to Gov. George Pataki's proposed $1.9 billion reduction in the New York state healthcare budget.

"To get Housing and Urban Development financing, you have to maintain certain cash levels, which has also restricted our capital budget," Moroses says. "We've put several IT projects on the back burner because of that." Moroses is using an older Eclipsys 7000 for EMR - a way of keeping patient health information online rather than in paper-based charts.

"At one time, we were going to move to the newer Eclipsys SunRise Medical Record platform," Moroses says. "We also wanted to expand use of the ambulatory medical record and looked at implementing a new anesthesia medical record. Those got pushed back or postponed."

The computerization of traditionally paper-based medical records and the automated entry of labs and medications is such a highly charged area that Kaiser-Permanente Health System in Oakland, Calif., says it will shell out $1.8 billion to implement the technology to reduce medical errors for about 8.4 million patients. A 1999 Institute of Medicine report said that as many as 98,000 patients die each year from errors that are medically preventable.

"That study has spurred the issue of medical errors into the limelight for healthcare," Young says. "That's where IT has come into play for a lot of organizations in that they can be automating paper-based processes, whereas a paper-based process is quite prone to errors and misplacing of paper, misfiling or somebody getting access to it who shouldn't."

Dispensing meds and labs

Among the users implementing electronic physician order entry is Patsy Sublett, clinical systems manager for Danville Regional Health System in Virginia.

"Even before the Institute of Medicine report came out in 1999, we've been very much in tune to patient safety," Sublett says. "We heard that Siemens was developing a bar code [and software] point-of-care system and thought it would be neat if we could be the test site for that system." Already a lot of Danville's drugs contain bar codes, so dispensing them to patients whose wristbands could be similarly bar coded made sense. Considering that the hospital has used EMRs for some time and found that it reduced errors, Sublett decided to go ahead. "We had to purchase wireless bar-code scanners and create a patient bracelet with a bar code on it," Sublett says. "The other big thing we had to do was, even though about 40% of our medications were coming into the facility with a bar code on them, there was another 60% that we had to repackage with a bar code."

After running the project for two months, Sublett presented to the hospital's board of directors a recommendation to roll out the system hospitalwide.

"At that point it was just about on a daily basis that we could see a potential error that was being averted by the system," Sublett says.

Computer-based order-entry software creates alerts to remind nurses of measures they need to take before and after dispensing drugs. For instance, Sublett says, a nurse might receive an alert to check on patients after dispensing pain medication to see if the pain has diminished or one that compares drugs with other medications a customer is taking for adverse drug reactions.

At Denver Health, Pelot says order entry is his biggest project. "That's to ensure that the person inserting the order is the person giving the orders," Pelot says. "It's more of a patient safety and quality-of-care initiative than anything else. The whole idea behind it is to use the computer to prescribe medicine and avoid contraindications and reactions that could occur from drug errors. This could reduce the drug errors that could occur.

"A lot of times the wrong prescription is given because the pharmacy can't read the doctor's writing," he says.

Wired access anywhere, anytime

Todd Peterson, IS manager for Meriter Hospital in Madison, Wis., is looking at combining electronic data entry and medical records with tablet PCs and wireless technology.

"In the next phase of our Epic [software] project, we'll have to go with some type of wireless device at the bedside," Peterson says. "My gut feeling as I look at the technology is that the tablet PC is going to be the correct solution. To view the same data on a PDA, such as a Palm, you're just never going to have the screen that you're going to need."

Moroses, who already has EMR at Maimonides, also is looking into wireless and handheld use. "We've gotten CPOE and EMR up and gotten 100% physician use of those, so we've been pretty successful over the last two years," Moroses says. "What we are doing now is making those [records and methodologies] accessible anywhere, anytime."

Moroses, who had planned to use laptops to host his portable medical record, now is considering "leapfrogging that to the tablets. The big thing is the weight - if the nurses and physicians are going to carry these things around for a long period of time, a pound makes a difference."

Young says that in spite of wireless' advantages, there are several obstacles that will slow its adoption.

"The main area of concern is the security of the wireless infrastructure for hospitals, also in terms of device security," Young says. "Wireless or mobile devices have a very strong value proposition in healthcare settings. It's just really being able to resolve some of those security issues, as well as the mindset issues and workflow issues associated with adopting those types of devices. Doctors who are used to writing prescriptions on pad and paper would have to change their habits."

Those issues also affect CPOE and EMR.

"We know that we're going to have to move to bedside charting to get an [EMR] and we know we're going to be going with a wireless solution," says Carla Smith, executive vice president of the Healthcare Information and Management Systems Society, an industry association that helps members use IT and management systems to improve patient care.

"The industry is changing so much as it relates to wireless connectivity with the new standards coming out, and then there's a security issue side of that," Meriter Hospital's Peterson says. "What devices are we going to use, what protocol, and really how do you tie the telecommunications side and the data communications side into one acceptable solution for both ends?"

(C) 2003 Network World. via ProQuest Information and Learning Company; All Rights Reserved

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