Will Technology Rescue the U.S. Healthcare System?Published: April 09, 2003 in Knowledge@Emory
When the Institute of Medicine released its 1999 book “To Err Is Human: Building a Safer Health System,” the findings, while stunning, came as no surprise to many in the healthcare community. The authors noted that hospital errors accounted for up to 98,000 deaths each year in the United States, with mistakes in diagnosis and improper dispensing of medicine resulting in, or contributing to, patient illness and death at an unacceptable rate for U.S. hospitals and clinics. The industry advisory organization noted that, among the many recommendations to improve the out-of-date systems at most hospitals, incorporating information technology improvements into the very fabric of medical facilities would vastly improve healthcare delivery.
In the increasingly complex and chaotic environment of U.S. healthcare facilities, doctors, nurses, hospital administrators, and a litany of staffers ferret through stacks and stacks of patient processing forms, medical records, diagnostic test films, handwritten physician reports on patient status, and private and government insurance paperwork. Understandably, with hospitals and clinics in their current state, patient treatment as well as efficiency can be compromised.
As the debate rages over the best way to address the woes of a behemoth healthcare system, many on the insurance, healthcare provider and governmental side of the fence do agree that digital technology can resolve many of the processing errors, paperwork bottlenecks, and diagnosing and medicine dispensing errors in the system. The Institute of Medicine, along with the Leapfrog Group, a consortium of private and public healthcare purchasers addressing patient safety issues, have recommended computer-based physician order entry (CPOE) systems, as well as computerized access to medical tests and health records. The integration of this sort of technology, they say, would provide doctors with fast, real-time access to medical information and facilitate the flow of data necessary for insurance and patient processing. The Leapfrog Group estimates that CPOE alone will “reduce serious prescribing errors in hospitals by up to 88%.”
In February, the death of a young Duke University Hospital patient, 17-year-old Jesica Santillan, after a blood-type mismatch in a heart-lung transplant procedure, made it clear how medical errors can result in devastating consequences. Those in the healthcare community see technology as one antidote to some of the problems that can occur in the processing of medical information. John T. Fox, president and CEO of Emory Healthcare in Atlanta, notes, “Patient safety overall needs additional emphasis throughout healthcare. The recent tragedy at Duke brought this message home for all of us in a very clear way.” Referring to the electronic medical record initiative being instituted at Emory Healthcare, he says that the system “will reduce variation and avoid miscommunication compared to our current potpourri of communication methods for clinical instructions.” He sees the “reduction in inadvertent errors and variation in communication” as the largest benefits of electronic medical information.
Dr. William A. Bornstein, chief quality/medical officer for Emory Hospitals in Atlanta, notes that the implementation of digital technology into the backbone of a healthcare facility can “ultimately free up physicians from the onerous task of paperwork, allowing them to provide a better level of care to the patient.” Dr. Bornstein also serves as an advisor to the Leapfrog Group. In-depth technology efforts, such as that being implemented at Emory Healthcare, integrate all of the various departments of the hospital, allowing for improved delivery of care and more efficient administrative functions.
Emory Healthcare is in the process of instituting a $27 million paper-free electronic medical records system, which launched in July 2002, and is expected to be completed in 2012. The result: the end to all paper patient records for outpatient and inpatient treatment at all of the facilities comprising the Emory Healthcare system, including Emory University Hospital, Emory Crawford Long Hospital, The Emory Clinic, the Wesley Woods Center and the Emory Children’s Center. Physicians will be able to enter and retrieve patient information electronically, via a secure database. “The adoption of technology is key for many of the country’s largest hospitals and health systems, due to the quest to increase quality of care, lower the incidence of medical errors, improve patient and provider satisfaction, and adopt standardized decision support and treatment pathways,” confirm Dedra Cantrell, RN and chief information officer for Emory Healthcare.
Additionally, Dr. Bornstein notes the implementation of an inpatient computer-based physician order entry system (CPOE) at Emory Healthcare by December 2004. He indicates that CPOE will facilitate better communication between busy doctors and nurses, and provide real-time access to clinical data for the many medical practitioners treating the patient, even if those physicians may be in disparate parts of the large medical system. Another plus is that doctors will no longer need to decipher one another’s handwriting, because the data will reside on an easy-to-read computer screen. As well, with a few short clicks of a mouse, doctors can easily crosscheck possible drug interactions and dosing levels for the plethora of medications on the market.
Another update in the Emory Healthcare system includes the Picture Archiving Communications System (PACS), currently being put in place. Hospitals have become huge warehouses for the many films created by x-rays and other similar tests. PACS makes the current problems with storing and accessing the exorbitant amounts of film from medical diagnostic procedures moot, as it all becomes a digital image, stored and easily retrievable from a computer. Cantrell adds, “At Emory Healthcare, it is not about going electronic for the sake of going electronic; this is not about just automating the paper medical records or digitizing films, although a byproduct will be the elimination of the paper as we know it today. The initiative we have underway is about transforming patient care.”
Similar technologies to those being utilized at Emory Healthcare are being deployed at a number of other medical facilities throughout the country. According to Jon Trigg, director of the healthcare division of Siemens One, the solutions marketing arm of Siemens, “In healthcare, there are significant pressures to contain, if not reduce costs, and a definite drive to improve patient care. There are cost-savings in the implementation of this technology, simply by the coordination of services and delivery.” Siemens One provides integrated systems for a variety of industries, including the healthcare community, with such products and services as medical, diagnostic, therapeutic, and patient monitoring equipment, as well as telecommunications solutions, environmental controls, security systems, and energy distribution technology.
Siemens One currently works with a variety of healthcare institutions to “digitize and integrate” their medical operations, improving workflow, efficiency, and patient safety, as well as raising top and bottom line performance. In March, the company announced it had entered into a multi-year alliance with Scott & White Memorial Hospital and the Scott, Sherwood and Brindley Foundation to develop the Center for Advanced Medicine, a fully integrated, all-digital healthcare facility in Temple, Texas, scheduled to open in 2005. Siemens One will outfit the hospital from top to bottom, fully integrating healthcare information technology applications into the infrastructure, with appropriate medical equipment, telecommunications, and power and “smart” building technologies (including fire alarms and other security features).
Both new and existing facilities can benefit from integrating their digital technology systems. Trigg admits that coming into pre-existing hospitals is more challenging. But, he says, it can be done, and it produces much greater process efficiencies. “We work with many customers to move their systems framework from disconnected islands of technology to an integrated solution, on a time and project schedule that minimize disruption to their operations. It depends on the facility, as to what needs to be improved first. We take a look at where the best value will be, and phase in the changes over time. The project evolves in a prudent way, with efficiency gains funding the next project.”
Many healthcare institutions face serious cost overruns and belt-tightening budget plans, and targeted technology improvements can be the way to rejuvenate a lagging bottom line. While the jury is still out on the total, long-term level of cost-savings to be generated by incorporating digital technology into medical facilities, it is clear that a much more efficient operation will ultimately lead to improving medical care and administrative flow, and in turn, should create savings in the long run. Dr. Bornstein notes, “Our task is to make sure, as much as possible, that the quality of care is put first, and then we look at how to improve efficiencies to pay for these technologies.”
The initial setup costs of the technology, as well as the difficulties and time involved in integrating the technology into pre-existing medical facilities, does make many in the industry balk at the idea of major overhauls in their day-to-day operations. Industry estimates indicate that only about 5% of U.S. hospitals currently use computer-based physician order entry. Barbara A. Maaskant, chief information officer and senior lecturer in decision and information analysis at Emory's Goizueta Business School, notes that the stakes are high for healthcare facilities, if the implementation of new technology fails to accomplish its intended purpose. For most hospitals, she says, the changes that need to take place are monumental. However, there is no room for error, especially when patient safety and overall hospital efficiencies are at stake.
Geraldine Cruz, senior analyst in the IT Services group for the research firm Gartner Dataquest, adds, “Despite the compelling drivers to IT spending, the healthcare industry’s constrained ability to invest capital, and its difficulty embracing IT systems, will hinder new IT initiatives.” The Gartner Dataquest Market Databook, December 2002 Update, notes IT spending for 2003 will remain lackluster across all areas of industries. But, according to the report, the industries that are projected to show the strongest growth in 2003 and 2004 are healthcare and government.
The drivers for investment are already in place. Private and government insurers are pressuring hospitals to computerize medical information, in order to facilitate the exchange of efficient, timely and accurate patient medical and insurance data. The nation’s hospitals are also facing increased fines for Medicare and Medicaid claims billing errors. Additionally, the Health Insurance Portability and Accountability Act, passed by Congress in 1996, is forcing medical facilities to simplify electronic transactions to healthcare insurance payers and provider organizations. The phase-in of the regulation will require full compliance by medical facilities in October 2003.
The various outside forces and pressures will, in turn, create a variety of business opportunities for those providing technology products and services to the healthcare community, including such companies as Siemens, Cerner, Subimo, deNovis, Ingenix and others. In a report from Forrester Research titled “Forrester’s Top 10 Healthcare Predictions For 2003,” the business research firm predicts that human resource and benefits administration software companies, like ProAct Technologies, will also have a tremendous opportunity in the benefits portal market, as hospitals look to quickly resolve their paperwork woes to comply with increasing government regulation.
A number of consortiums in the medical community are also fighting to bring the healthcare system into the 21st century. One such group, the American Telemedicine Association, continues to advocate for the increased use of technology that facilitates medical education, as well as patient treatment and diagnosis via Internet linkups. Currently, a limited number of patients in far-flung locales benefit from “tele-consultations” with specialists in different cities. Using this type of system, patients with chronic conditions receive medical monitoring while at home, with simple-to-use diagnostic equipment that the patient can access to measure blood pressure, pulse or heart rate. That data is then sent electronically to the doctor’s office.
The American Academy of Family Physicians is also spearheading a technology initiative, championing the creation of an industry-wide open source electronic medical records system, taking the idea of electronic medical records at a hospital a step further. Their goal is to enable all health institutions and providers to use a standardized computer system, so that patient data could be easily transferred electronically from one provider to another.
Whether change is forced upon the industry as a result of the various governmental and malpractice considerations, or if it happens due to the growing front of forward-thinking advocates and organizations, the efforts come as a much-needed antidote to the problems facing modern medicine. Fortunately, for the safety of patients and the long-term health of the industry, technology can serve as a powerful treatment for many of the ailments plaguing U.S. hospitals and clinics.