Can High Tech Save Your Life?
It just might: Computer use in hospitals is now linked to lower death rates
It is just before 1 p.m. on a Friday in late June, and Brenda Coulter is making her rounds. Coulter is an intensive care nurse, and she's checking on a patient coming out of heart-bypass surgery at Aurora St. Luke's Medical Center in Milwaukee. But she's not actually at St. Luke's. She's in a low brick building several miles away, closer to the Milwaukee airport than it is to the hospital. "Hello, how are you? I'm Brenda Coulter, a nurse, just making sure everything's OK," she says into a microphone. On one screen in a bank of five computer monitors in front of her, a man looks up from his bed, his face partly covered by an oxygen mask, and nods his head. "Good," Coulter says. On another screen, the man's heartbeat traces a regular rhythm, up and down, up and down.
This is the Aurora eICU, from which a team of doctors and nurses keeps constant watch on more than 10 intensive care units in four different hospitals spread across eastern Wisconsin. The idea is not to make care more remote. "Actually, the goal is to bring expertise to a patient's bedside faster than we ever could before," says David Rein, the unit's medical director.
Rein is a critical care doctor. Most hospitals have them, as well as nurse specialists like Coulter, and most also have trouble getting them to look at all patients in all ICU s on all different floors. The clinicians aren't sloths. They simply can't be in two--or 10--places at once. That is, unless they're in the eICU. From their workstations, Rein, Coulter, and three other nurses control cameras that can zoom in so tightly they can see capillaries in a patient's eyes. Monitors display vital signs and a patient's electronic chart, which records medications and the time given, notes on their condition, lab test results, and X-rays. Not only can Rein and Coulter spot trouble early; they also can coach nonspecialists in the patient's room about what to do to fix it.
This is one of the more dramatic examples of the "wiring" of America's hospitals, as health systems try to harness information technology to improve the quality and safety of care. A few weeks ago came the first strong evidence that all this gee-whiz high tech can make a difference. A large survey of hospitals identified the "100 Most Wired," and, when compared with other institutions, their patient mortality rate was 7.2 percent lower, on average. That held true no matter the hospital size or whether it was an academic medical center.
That has a lot of healthcare researchers excited. While the survey--conducted by Hospitals & Health Networks , a publication of the American Hospital Association--doesn't prove that technology actually causes better patient outcomes, it does show there is a strong connection, says Carolyn Clancy, director of the federal Agency for Healthcare Research and Quality. "Many hospitals are struggling with technology right now, and this survey offers a beacon of hope."
That struggle was highlighted a few months ago in a Journal of the American Medical Association study of "computerized physician order entry." Computer systems had been widely hailed as the big fix for medication-ordering errors (sloppy physician handwriting, obscure abbreviations, etc.) that can kill patients. But the study showed that such systems could actually introduce new errors, such as double dosing, that can be just as bad. "If a system's screens are badly designed, if they don't ensure clear communication between nurses and doctors and pharmacists, they are going to create mistakes," says physician Graham Hughes, vice president for product strategy at IDX, a developer of computer systems for healthcare.
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