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.
Poudre Valley Hospital in Fort Collins, Colo., one of the 100 Most Wired, learned this firsthand when it introduced electronic patient records into its emergency department. "The screens didn't fit how the doctors and nurses worked. They wanted to note vital signs about a trauma patient's condition, but the first screens were asking about next of kin and insurance information," says Craig Luzinski, the chief nursing officer. "There's a standard protocol for stabilizing a patient: Check the airway, then breathing, then circulation. But the circulation screen popped up first. So people just didn't use the system." That's not good if the goal is to input treatment info that will follow the patient through the hospital so other caregivers can use it to make better decisions later on. "It took us a few days to get it to the point where the docs were happy. And now they all use it."
Use of electronic health records by most staff, in most situations, is one factor that distinguishes the 100 Most Wired and may play into better outcomes. "It's not the technology but the culture of using it and getting everyone to buy into that," says physician Scott Thompson, vice president for medical operations at Aurora St. Luke's, another hospital on the Wired list. If a nurse administers an antibiotic, the timing has to be noted in the computer so Rein, over in the eICU, can call up the chart and see whether the patient's heart rate has changed because the patient is still fighting an infection and the drug isn't helping. So the St. Luke's system prompts staff to enter the time a drug was given, and places computers so staff have easy access.
Poudre Valley made sure nurses and doctors are part of the technology committee, so they can quickly spot and fix glitches like the ones that cropped up in the emergency department. And Luzinski's hallways are lined with wireless COW s, or computers-on-wheels, so staff can update records while tending to a patient, as well as get reminders of "best practices" for treatment.
A hospital does not have to be wired to make this effort, of course. Metropolitan Hospital in Grand Rapids, Mich., is not on the list of 100, yet it is one of the nation's leaders in medication safety. "We've done a lot of things with staff education," says Pete Haverkamp, the director of pharmacy services. "But we also cut out distractions for pharmacists. We put colored tape on the floor around the area where they check orders. It signals everyone else to leave them alone." The percentage of patients with problems due to improper narcotic or sedative orders dropped, within a year, to zero. And the place is so unwired that the tape wasn't even electrical.
More information on the Most Wired Hospitals appears at usnews.com/wired .
This story appears in the August 1, 2005 print edition of U.S. News & World Report.