Hospitals

Hospitals are complex social organizations and are managed very differently from the top-down style of commercial businesses. The hospital's medical professional staff provides services to patients. On the other hand, presenting, storing, and managing patient data is the job of the hospitals IT administrative staffnot the medical professionals delivering services. As a result of this and a number of other factors, hospitals have been typically slow to automate their patient records processes. However, the impetus to create the electronic patient record has given doctors and administrators reason to come together.

Other parts of our lives are already chronicled and recorded electronically, and as the Inescapable Data movement progresses other missing parts will get filled in. If you call many nonmedical service providers for assistancesay your automobile dealeryou typically hear a keyboard clicking in the background as someone retrieves an electronic record of your account that contains your addresses, phone numbers, car purchase date, car make and model, service history, and important tie-ins to manufacturer-recall information, safety information, and perhaps even some information that allows an opportunistic salesperson to make a pitch. By contrast, if you call your medical provider, an attendant may put you on hold while he or she physically retrieves your record from an aisle of color-tabbed folders. If, perhaps, your eye specialist has some of your patient data online, you can be sure that he has no interface to your cardiologist.

Dr. Peter Slavin, CEO of Massachusetts General Hospital, understands the importance of both having electronic patient information and of sharing it:

Electronic patient records are a huge advancement in the world of hospitals and clinical care, enabling a whole new level in better patient care. This is long overdue, and there are many contributing reasons to the delay. Part of it is related to cost. In the profession, we tend to prefer to put money into actual equipment, medicine, or professionals. Another part of the reason is due to most doctors operate independently and as such have independent systems, either electronic or manual, that meet their specific needs and uses. These two elements are changing. For one, as a group, we're realizing the absolute cost and efficiency benefits of increased electronic records and connectivity, primarily through speedier care and record keeping, but also in better safety. Second, the size of various HMOs and health groups have been growing steadily, which affords efficiency gains and has provided the new opportunity to have consolidation and integration of back-end resources.

Slavin admits he is a bit of a pioneer in this field. Another one of the challenges he faces is that hospitals can differ greatly in the ways they track patient and lab data versus the ways this data is handled by individual medical practices. Both sides have been slow to evolve their patient records automation processes and have typically done so independently of one another. This leads to disparities that require integration of data sources.

What is the value of a paperless medical record? Aside from the obvious benefits of faster service and more complete per-doctor histories, the real value comes from the ability to integrate a number of different data sources. "Any doctor in the Partner's network can understand the various history and treatments of a particular patient," explains Slavin. "This can have dramatic benefits. A doctor treating a patient for a routine eye examine will now have his cardio record directly at his disposal, which could very well have important relevant information such as blood pressure history." Slavin goes on to explain that the benefits run deeper and include a more accurate understanding of prescription drug usage and interactions, because all that data can referenced automatically when needed, helping doctors avoid a great many of the preventable problems. This is squarely an Inescapable Data visioninterconnection of many different sources of data to derive far higher values than any single source would produce on its own.

One of the most interesting hospital settings that Inescapable Data technology is showing up in is the operating room. Slavin describes some pioneering work Partners is doing designed to greatly improve the utilization of operating rooms and patient care. At the heart of the new OR is RFID in the form of tags placed on patients. Currently, every patient admitted to a hospital wears a plastic ID braceleta practice unchanged for many decades. Bar codes on bracelets have been in use in some hospitals, but those are cumbersome and slow in comparison to RFID tags that can be instantly detected.

How might RFID be exploited in an operating room setting? "As a patient is wheeled into the OR, the operating room computer systems will know that this is John Doe and what are the scheduled procedures. Furthermore, the system will know what machinery and tooling and medication is needed and can verify that only the proper items are in the room. All of this greatly cuts down on the time to verify everything and most importantly a reduction of preventable mistakes and higher utilization of the room, the staff, and the machinery."

Beyond the OR, RFID usage can be expanded to other areas throughout the hospital. RFID in the operating room can become a model for in-room patient care, for example. Whenever a medicine is dispensed in this setting, the hospital's internal system can wirelessly and remotely scan RFID tags on the medication containers to verify that it is the proper prescribed medication for that patient. Too often, well-meaning nurses and aides will administer the wrong medication because of any of a number of reasons, such as room turnover (to a new patient) or the doctor not informing all the floor personnel.

Separately, a new concept has emerged that specializes in augmenting the life-critical task of monitoring patients in intensive-care units (ICUs). VISICU, Inc., a Baltimore-based company, is the innovator of a technology system, the eICU solution, which addresses patient safety like never before. "From a central location, a hospital system links critical-care physicians and nurses to ICU beds across multiple hospitals for remote monitoring patients 24 hours a day," describes Frank Sample, CEO of VISICU. He continues:

The same data available in the patient's ICU room is connected to our remote system, and also incorporates live video feeds, and a direct hotline to both the patient's doctor and the nurse or physician in attendance. The remote eICU facility is tied into the patient's care plan established by the attending physician and can deal with unforeseen situations extremely fast. Many problems are controllable if caught early enough but can rapidly become acute otherwise. In fact, Sentara Healthcare of Norfolk, Virginia, documented a 27% reduction in hospital mortality along with a 17% reduction in overall hospital length of stay using VISICU's eVantage system.

Sample goes on to explain that modern ICU medical equipment is not only computer based but also designed for connectivity to other systems for sharing data or monitoring. The addition of high-quality video cameras provides important visual patient information and is only accessed when needed. Network speed and associated decreased communications costs now allow for transfer of all this data, thus enabling the success of such efforts. The technology, business values, and client benefits are adding up.

Although there are indeed significant cost savings for hospital systems that employ the eICU solution, the driving factor in remote ICU monitoring is truly improved patient care and outcomes. Often, small problems that develop with an intensive-care patient can swiftly deteriorate into critical conditions. Even a well-staffed hospital ICU may not detect or may miss the early opportunity for correction because the attending physician is off site or with another patient, hence the need for an augmented monitoring process. What hospitals are using this new approach? Currently, larger hospital networks are early adopters due to the size of their ICU operation. The hospital provides the physical location for the remote facility and staffs the eICU center with their critical-care doctors and nurses. VISICU provides the eICU technology, methodology, and system training. The dramatic cost savings come not from reduced physician and nurse staffing, but rather through a decrease in outlierspatients who spend more than six days in the ICUand hospital mortality. Overall, this represents a pretty good win for everyone, enabled by high-speed networking, hardware and software interoperability, and data assimilation.