Healthcare IT

One of the fastest growing sectors in today’s economy, healthcare IT is increasingly becoming a top priority for hospitals as they move towards automating clinical processes, a monumental undertaking that is not only expensive and time consuming, but also requires deep cultural changes. “It’s a lot more than just plopping a good system in,” said Dr. Peter Spitzer, Chief Medical Information Officer at Providence Health & Services California who will oversee a multi million-dollar push to automate clinical processes at five southern California Hospitals including Providence Saint Joseph, Providence Holy Cross, and Providence Tarzana. “It requires a very significant effort in pulling together physicians, nurses, pharmacists and other clinicians to standardize the way we do things.” The significance of this technological push, and the hospital’s level of commitment to move towards a paperless environment, is marked by Providence’s creation of a CMIO position, he said. As CMIO, an emerging specialty (there are only 300-500 full time CMIO positions in the U.S.), Spitzer represents the intricate marriage between medicine and technology. A Harvard Medical School graduate who also earned a master’s degree in Electrical Engineering and Computer Science from MIT, Spitzer will help customize and configure systems that aim to standardize complex processes and practices that doctors deal with on a regular basis. “The goal is to work towards a paperless environment where physicians use the system for all of their patient care related activities,” Spitzer said. Like Providence hospitals, more and more health care providers are moving away from the paper-based system, nudged on in part by looming healthcare reform under President Obama’s administration and its plans to invest $17 billion dollars towards this end. Valley Presbyterian Hospital in Van Nuys is one of them. The hospital will invest an estimated $10 million towards automating and standardizing clinical processes there. “It’s a huge undertaking for the hospital,” said Chief Information Officer Ray Moss, who is leading efforts to implement Electronic Nursing Documentation working closely with Chief Nursing Officer Judy Maass, to standardize and automate the way nurses input patient data. The system is expected to go live by February 2010. The next phase will be to put systems in place that allow physicians to input data electronically, including patient orders, histories, reports, doctor’s notes, and daily progress notes among other information. Investments in technology constitute about 30-40 percent of VPH’s budget. Overall, a $16.6 million capital investment in technology has turned the hospital around in the last three years, and Valley Presbyterian has jumped from being a financially troubled, obsolete institution, to a cutting edge, state of the art facility. “Three years ago, the hospital was operating with computer systems that had sunsetted some five years earlier,” said Gregory L. Kay, M.D. interim Chief Executive Officer at Valley Presbyterian Hospital. “Today VPH is one of the fastest growing hospitals in the area. Daily patient census has increased over 25 percent,” he said. The technological makeover that the hospital has undergone includes the purchase of a 64 Slice CT Scanner, a new digital radiographic and fluoroscopy room, a GE Millennium Nuclear Medicine Camera, as well as the purchase of a full line of high-fidelity mannequins that offer state of the art training for clinical staff. The hospital is also implementing electronic status boards in Emergency and Surgery departments to better manage patient flow by electronically tracking patients from the minute they enter the ER, until they are discharged. A new physician portal provides doctors secure online access to a variety of patient care services and information. “This is giving us parity with some area hospitals and putting us ahead of others. Technology certainly gives us a competitive advantage,” said Moss. A poorly automated industry Traditionally, when it comes to the way patient data is collected, stored and shared the healthcare industry has fallen way behind the technological curve. “The healthcare industry is clearly poorly automated on the clinical side. All hospitals have automated their administrative, billing and financial systems but less than eight percent have electronic medical records, another 30 percent are working on it. Something like 20 or 30 percent are working on implementing physician order entry,” said Spitzer. According to a study published in The New England Journal of Medicine in March, fewer than two percent of acute care hospitals have a comprehensive electronic health record system in place, with another eight to 12 percent using a basic system. One exception is Kaiser Permanente which began the electronic transformation years ago. All of Kaiser’s medical clinics and two-thirds of its hospitals operate in a paperless environment and the rest are scheduled to be completely digitized by 2010. Across the system, about 14,000 physicians access electronic medical records for 8.7 million patients in nine states and the District of Columbia. “We’re delighted with our progress on electronic medical records, we think that everyone should be moving as aggressively as we are, we think it provides a higher level of care and it it’s the future of the industry,” said Robert Latting, Assistant Administrator at Kaiser’s Panorama City Hospital. Latting is one of four administrators at the Hospital, whose job is also to oversee and support Health Connect, Kaiser’s internal computer system that all doctors and medical practitioners use. It’s the system that physicians use to document patients’ vital signs, input doctor’s notes, and diagnosis information during a routine physical; and the same system that emergency room physicians use to access that same information if needed. Kaiser is so electronically integrated that members can look at their doctor’s calendar online to check his/her availability and schedule an appointment without ever having to pick up the phone. They can e-mail their doctor questions and also download and print out their kid’s immunization history at home without having to speak to anyone. The integration of electronic systems has given Kaiser a significant competitive edge, according to Latting. Kaiser is leading the country in prevention, he said, largely due to an electronic feature called “proactive office encounter” which alerts the receptionist at the time a patient checks in, of any preventive screening exams that might be overdue at the time. The receptionist then offers to schedule an appointment for the patient. As other hospitals move to catch up to Kaiser, Latting says the benefits are well worth the headaches and the costs; but the challenges can be daunting. “The amount of information that is generated by a hospital visit is astounding. People will be on machines that are taking constant readings of different systems, blood pressure, heart rate and other things and so you have to figure out how to capture and retain that data and display it in a way that is useful,” he said. “There’s also the very significant issue of privacy, which is really a big deal in health care. You have workers that need the information in order to provide the high quality care but we also want to limit the information to only those people that need to know for a clinical reason.” Challenges on the physician side Although KAISER breaks the mold with its network of integrated physicians, most hospitals operate in a setting where doctors are independent from the hospital. As independent practitioners who are not employees of the hospital, doctors are used to their own way of doing things. Implementing a standard electronic system for data input and collection on the physician side can be costly and require profound culture changes. “Part of the cultural and historical background is that physicians are used to doing things their own way. Although there has been much work in coming up with practice guidelines and protocols over the years by different specialties, they have only marginally been implemented,” said Spitzer. There is also a huge gap between older physicians and the younger generations, when it comes to technology, said Moss. “Older physicians are pretty set in their ways. Some have little or no knowledge of computer technology, and then there are the young hot shot doctors who are coming out of med school knowing everything about computers and expecting everything to be fully automated. Bridging that gap is part of our challenge,” Moss added. Ultimately, systems like Computer Based Physician Order Entry can provide decision support to doctors through warnings if the doctor is entering a dose that is too high, or too low, or if there appears to be a drug allergy interaction, said Spitzer. The system will even alert the doctor if a dose needs to be modified because the patient has other complications like kidney or liver problems, he said. “For all these reasons, having the physician enter the order through a computer rather than just scribbling it down or dictating it to a nurse can improve quality and reduce complications,” he said. “The thing is that if the systems don’t work well, or are not user friendly or easy to use, they can be a major annoyance.” On the nursing side, the move to paperless healthcare records is also a monumental task. At Valley Presbyterian Hospital, Maass, the Chief Nursing Director, has to work closely with the nursing staff in order to help customize sophisticated software systems to meet the hospital’s needs and culture, and come up with ways to standardize complex processes. Improvements like bed side charting systems where nurses record patient’s vitals signs and other information directly into a computer; and computer systems that provide bed side medication verification, will ultimately improve accuracy and safety for the patients. “It’s becoming nearly impossible to practice medicine today without some kind of tool,” she said, referring to the automation and standardization of medical practices. “It’s the future of the industry.”