A High Dose of Tech
"Some grocery stores have better technology than our hospitals and clinics." Tommy Thompson, secretary of health and human services
But while hospitals are starting to embrace technology, many are doing so tentatively, having observed the bruises suffered by early adopters. It's not just high cost, or software that needs further tweaking. Old-fashioned stubbornness has been a source of frequent hiccups and occasional debacles. And notwithstanding Thompson's grand plan, a blueprint remains to be drawn up, so wiring up is being done piecemeal. A healthcare system with a number of small or rural hospitals might opt first to fund remote intensive-care monitoring. California hospitals, on the other hand, must submit detailed plans for reducing medication errors by next January, so they might focus on computerized drug orders.
Three features of wired hospitals are especially meaningful to patients: taking the guesswork out of ordering medications, preventing errors when medications are brought to the bedside, and giving patients access to their medical records through a website. For a closer look, read on.
Killer prescription pads
A small piece of paper doesn't look like a deadly weapon, but much of the concern over patient safety and hopes attached to technology have centered on the innocuous prescription pad. No one seriously argues that relying on handwritten drug orders is anything other than antiquated, inefficient, and dangerous. Many of the more than 1 million serious medication errors estimated by Leapfrog to occur in hospitals every year, killing 7,000 patients and driving up healthcare costs by an estimated $2 billion, start with a physician's sloppy scrawl.
The high-tech remedy is computerized physician order entry, or CPOE. Placing orders by computer for medications--and, as a side benefit, for lab tests, special diets, and other procedures--not only eliminates confusion caused by barely legible scrawls but moves medications to patients faster and minimizes the possibility of incorrect dosages and dangerous drug interactions.
In studies, CPOE has cut serious medical errors by 55 percent or more, and Mark Zielazinski, chief information officer for El Camino Hospital in Mountain View, Calif., thinks that may be too conservative. The hospital started using computerized order entry more than 30 years ago--the first in the country to do so, says Zielazinski--working in tandem with Lockheed Martin. Error rates weren't recorded until 1992, but since then, he says, the number of errors per 1,000 patient-days has dropped from approximately 12 to six last year and now stands at four, a decline of 67 percent in a 12-year span.
In a CPOE-equipped hospital, the physician logs in to a computer that might be a terminal in a corridor niche, a laptop on a wheeled cart, or even, as at El Camino, a wireless tablet PC. Depending on the system, the doctor might key in the name of the drug and the dose, or point and click from a list of medications she regularly prescribes. The order is automatically forwarded to the hospital pharmacy and to nurses responsible for administering the medication.
Even a relatively narrow application like CPOE, however, demands a substantial foundation. A database consisting of detailed medical records for each patient in electronic form must be created and scrupulously kept up to the minute. Custom hardware and software packages must be installed. The human beings who will make or break the new system must be trained. Their cooperation is vital, and winning it can be tough.
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