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On the Ground: Building a Hospital IT System Print E-mail
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Friday, 31 July 2009

By Tom Groenfeldt

While politicians and lobbyists in Washington battle over the future of the health care system, Dr. John Beck in Sturgeon Bay, Wisconsin sits in the emergency room watching how physicians there use the computer system.

His goal is to identify problems that are easily correctable and then get them fixed.

"I sat and listened to the ER physicians grumble and then went to IS and we were able to make certain functions far more usable," he says. "The IS people have already taught the ER physicians how to use the system, so as far as they are concerned, it is job done. "

Describing himself as a nearly retired family physician, Beck functions as a sort of consulting CIO for the North Shore Medical Clinic and the Door County Memorial Hospital in Sturgeon Bay. A long-time technology enthusiast, he recalls writing programs in dBase on an Osborne computer.

Now he is concerned with the hospital's progress in the seven levels of the Health Information Management Society's (HIMS) measurement of electronic health records. In some areas, such as computerized decision support, the hospital and clinic are approaching Level 6; overall it is probably at Level 3, he says. For example, it has implemented bedside verification for medication; each time a dose is administered, the nurse or aide scans a patient's bar-coded bracelet and scans the medication container and the information entered into the system through a computer in each room.

"One of the things we will institute soon is computerized decision support (CDS). When a physician enters a problem or disease, he can click to the latest publications and recommendations." Soon that information will be integrated with the patient records to flag the need for updated tests or checkups such as a pap smear or an eye exam for a patient with diabetes. The hospital already uses a prescription program which checks for allergies and conflicts between medications.

The system offers a protocol for treatment and the physician either follows it or enters an explanation of why he didn't think that action was appropriate.
Physicians, who value their autonomy and individual expertise, do not always take kindly to instructions from software. Beck says some physicians in Sturgeon Bay felt a lot was being crammed down their throats. So the hospital brought in a consultant to determine their concerns. As a result, the hospital established a physician advisory board and now decisions about the clinic systems come through that board.

Another way to improve acceptance is to make the system as easy as possible to use - through training, tweaking the software, adding functionality, and modifying roles. In response to concerns that physicians were spending too much time on data entry, some of those tasks were turned over to assistants. And when assistants complained they didn't have the ability to customize their screens the way the doctors could, Beck talked with IS to get that modification feature in the MediTech system turned on for them as well. Now all the users can design their table of contents page to get at the information they need quickly rather than running through several screens. Making sure the assistants are happy with a system is a key to making the physicians happy with it, he explains.

Electronic order entry is already used in the ER and will soon be across the clinic and hospital. Beck says it is a great time and error saver. It also lets several physicians access the information and communicate with each other on recommended treatments. In a summertime vacation area like Door County, where large numbers of the population leave for Florida or Arizona in the winter, electronic records allow the hospital to send a patient's file to the doctor or hospital he uses in the winter, alleviating the need for patients to lug around manila file folders of their case histories.

Will this save money? Beck says that is difficult to project.

"The primary goal of electronic health records is patient care and patient safety, but one thing that can do is eliminate a lot of waste." Standing orders to draw blood that aren't canceled when they are no longer needed, chest x-rays for patients who already have current data on file, missed procedures which have to be completed before a patient leaves the hospital -- all can provide room for savings if the system is implemented at a fairly high level, says Beck.

What the country needs is nationwide compatibility for medical platforms, says Beck, to make data compatible across encrypted systems.

"Rather than us printing a record and faxing it to the physician in Arizona, we should be able to just send the record electronically." Prescriptions are slowly moving electronic, although the hospital is still e-faxing many of their drug orders.

His request for software vendors will sound familiar.

"People that write code need to put themselves in the shows of an end user. Just because software does something doesn't make it all that great if it is not friendly to the end user."




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