Innovations in Technology Improve Health Care

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Hurry up and wait.

Soldiers know that mantra well, and until recently, so did patients who visited the department of orthopaedic oncology at Massachusetts General Hospital in Boston.

The drill used to be:

  1. Arrive at radiology a minimum of a half-hour early for your orthopaedics appointment.
  2. Wait to be called in for X-rays.
  3. Get X-rayed.
  4. Go back to waiting room and wait for films.
  5. Wait.
  6. Wait.
  7. If films need to be re-taken, repeat steps 2-8
  8. Pick up films.
  9. Schlep heavy, awkward films back to your doctor’s office.
  10. Wait.

Today patients don’t wait for their X-ray films. In fact, there aren’t any films to wait for.

“It’s similar to a digital camera,” explains Giles Boland, MD, director of teleradiology at Massachusetts General and associate professor of radiology at Harvard Medical School in Boston.

“The light is put on a light-sensitive plate and the image is recorded digitally. The advantage of that, aside from saving money on the film and processing is that you can tweak the contrast levels like you can with a digital camera, so that if you don’t get a good exposure you can make it into a good exposure.”

Digital Imagery

The hospital uses a picture-archiving and communications system that allows digital storage and display not just of X-rays, but also of CT scans, MRI images, and biopsy and you can see these images anywhere, he says.

Big deal, you say? It is if you’re the one trying to clutch an envelope full of X-rays while maneuvering hospital corridors balanced on crutches.

Not too long ago, only Superman had X-ray chemotherapy drug for treatment of prescription drugs and select over-the-counter medications as well.

The system, which is already in use in several hospitals throughout the country, works like this:

When John Q. Patient is admitted to the hospital, he is given a bar-coded ID bracelet that links him directly to his computerized medical record. Before Nurse Nancy gives him a drug, she scans the bracelet, which calls up John’s medical record, and then scans the code on the drug package. The information is whisked electronically to the hospital pharmacy, and the computer whirs into action, comparing the drug, dose, and time of administration with the prescription information already on file. If there’s a discrepancy, such as the wrong drug, wrong dose, or a change in the patient’s chart, the computer sends an error message to Nancy, who looks for the source of the problem.

The FDA estimates that uniform adoption of the barcode system will result in a 50% increase in the chance that a drug error will be caught before the drug is administered, leading to a drop in “adverse” drug events of more than 400,000 over the next two decades.

In addition to saving lives and preventing drug-related health problems (and the lawsuits that inevitably follow), a barcode system offers benefits that would warm the cockles of any managed-care Scrooge’s blood pressures and store their notes and so on,” explains Daniel Z. Sands, MD, MPH, assistant professor of medicine at Harvard Medical School, and clinical systems integration architect at Beth Israel Deaconess Medical Center in Boston.

He says the online medical record grew out of a need to impose order on the chaos of modern medical life.

“Medicine is increasingly complex, and we don’t have a lot of time to spend with you in the exam room. We’re dealing with an incredible amount of information and keeping track of this information isn’t really manageable using paper. Having a computer system there is a very important safety net for us, and it really makes it possible to provide quality Health Care Delivery Policy Program, at the Kennedy School of Government at Harvard University in Cambridge, Mass.

“All of this technology is possible and exists, and we know it’s possible because it exists in at least one place. But scaling it up has proven to be an absolute, insurmountable barrier.”

Despite more than 30 years of rapid development in computer technology, less than 5% of patient medical records are currently automated. The problem is that the people who hold the purse strings at hospitals tend to be interested in one thing, Grossman says, and that’s ROI, or “return on investment.” Information systems call for a big cash investment upfront and on uncertain benefits down the line.

But Brent C. James, MD, executive director for Intermountain Health Care at the Institute for Healthcare Delivery Research, and adjunct professor of family and preventive medicine at the University of Utah School of Medicine in Salt Lake City, tells WebMD that electronic record systems can work when health-care systems are large enough and have the cash, brains, and will to make them work.

The Intermountain Health Care system, which comprises 22 hospitals and more than 100 outpatient facilities, has been working toward an electronic medical information system for more than 35 years. “We passed a point, just in the last couple of years, where it’s showing a net return on investment,” James tells WebMD.

The keys to success, he says, were designing a system that wouldn’t make the jobs of doctors and nurses harder than they already were, and making sure that the system was part of overall efforts to improve the quality of health-care delivery.

“These types of systems, which we call advanced clinical systems, are still only in a minority of hospitals,” acknowledges David Classen, MD. “Somewhere between 5% and 8% of hospitals have these advanced clinical systems that can provide lots of clinical information to doctors and to patients and provide the platform to act on that clinical information through things like computerized physician order entry.”

Classen, who is vice president of the First Consulting Group in Salt Lake City, tells WebMD that about 40% of hospitals will have such systems in place over the next five years.

In addition to the high initial acquisition cost — about $8 million per hospital — health-care systems have been reluctant to invest in advanced clinical systems because early versions of these systems weren’t flexible enough to meet the complex needs of individual hospitals or physician groups, and those systems that were tested tended to make more rather than less work for harried doctors and nurses.

But the tide of negative opinion about advanced clinical systems is beginning to turn, Classen says, because employers and health insurers are beginning to demand them, and because hospital administrators and doctors are beginning to realize that “these systems can really reduce a lot of errors, and improve the quality and safety of patient care, ” Classen says.