Not long ago, Gerard Burns, M.D., could only envision a hospital where doctors monitored patients not just on regular rounds, but dozens of times a day, even from their homes and offices across town. A hospital where everyone involved in a patient’s care — from surgeons and nurses to X-ray technicians and pharmacists — could view the medical chart on demand, rather than having to wait in line for a single, paper copy. A hospital where medications were filled as soon as they were ordered, instead of watching prescriptions sit in a queue for periodic deliveries to the pharmacy.

 

Today, that’s no longer a vision but reality, as Hackensack University Medical Center has become one of the most high-tech hospitals in the nation. In recent years, the medical center has invested millions of dollars in information technology, including the purchase of wireless laptop stations that allow nurses and doctors to create an Electronic Medical Record (EMR) for each patient. The EMR always contains the most up-to-date patient information, along with medical history, and can be viewed by the entire team of professionals working on a case, regardless of location.

 

“Hackensack decided to look at the patient perspective: if you were a patient, what kind of care would you want? The highest quality, safest and most efficient. What’s going to help you provide those things? Information technology,” Dr. Burns said. “Information technology brings accurate and current information to the end users – in this case, the physician, the nurse, the pharmacist – to allow them to make the best care decisions at any given time.”

 

Dr. Burns, Hackensack’s director of medical informatics, said the impact of the investment is evident in improvements in both efficiency and quality. Lab tests are being performed more quickly, medications are arriving faster, scientific evidence is playing a larger role in treatment decisions, and doctors are able to be more involved with their patients.

 

As a result of the new IT and other efforts at the hospital, Hackensack’s mortality rate dropped 16 percent from 2002 to 2004, and its readmission rate dropped by 12 percent during the same time. Additionally, the length of stay – widely used in the hospital industry as a measure of efficiency – was reduced by 23 percent on floors where EMRs had been implemented, compared to a reduction of just 4 percent on other floors.

 

Those are substantial improvements, Dr. Burns said, that should make a difference to patients and the companies that subsidize their health care. “Employers should want their patients to go to hospitals where they’re going to get quality, efficient care so they can go back to work quickly and don’t have to be readmitted and don’t have disastrous complications,” Dr. Burns said. “That’s in the best interest of the employer – both from a cost standpoint and from the standpoint that it improves the health of their employees as well.”

 

 

Hackensack isn’t alone in promoting the importance of IT to health care. The employer-driven Bridges to Excellence Physician Office Link program encourages physicians to adopt technology-based care management systems, including electronic medical records. The Leapfrog Group promotes the use of Computerized Physician Order Entry systems, which allow hospital staff to enter medication orders via computers linked to error-prevention software. And in April 2004, a National Health Information Technology Coordinator position was created within the U.S. Department of Health and Human Services to advance the development of electronic health records.

 

According to a RAND Corporation study released in September, America’s health care system could save more than $81 billion annually and improve the quality of care if it were to broadly adopt computerized medical records. The savings would come through reducing redundant care, speeding patient treatment, improving safety and keeping patients healthier, the study found.

 

Even before the recent focus on getting wired, hospitals like Hackensack and Saint Mary’s Health Care in Grand Rapids, Michigan were leading the charge.

 

“We had lab results and X-ray results available on a computerized system going way back to the 1980s, but it was a rudimentary system,” explained David Baumgartner, M.D., vice president of medical affairs at Saint Mary’s. “That was supplanted by a home-grown system in the mid 1990s that took us to the next level with additional functionalities. It let us look at things like pathology lab reports – a big step forward – but it was still only a piece of the picture.”

 

In October, 2004 Saint Mary’s became the third hospital in the Trinity Health system to shift to a paperless environment. Among the new features, when nurses and other care providers fill out patient charts, all of the information is entered electronically. “Now you never have to fight over a paper chart – and when you think about the teams of people who have to take care of a patient in the hospital, that’s not an insignificant issue,” Dr. Baumgartner said.

 

Also, the system gives doctors access to patient charts outside of the office. “I had a patient a couple of weeks ago in the hospital who was having trouble with the amount of oxygen in his blood,” Dr. Baumgartner recalled. “In the old world I would have to call and pull the nurse away from whatever she was doing to find out the latest data on that patient. Now I can call up the information on a computer screen in 20 seconds and monitor the patient remotely. I can also manipulate the data and graph it and pull up the blood pressure alongside the temperature and urine output – it allows you to see the information in really different kinds of ways.”

 

 

Another important IT feature at Saint Mary’s is the Computerized Physician Order Entry system, Dr. Baumgartner said. In addition to reducing the chance of medication mix-ups based on difficulties translating some doctors’ handwriting, the system also speeds up the time it takes for a prescription to be filled by sending doctors’ orders to the pharmacy in real time.

 

“Any time you can speed up the process of delivery of care, that’s an improvement,” Dr. Baumgartner said. “If I have a patient in pain and the pain medicine I’ve ordered is not adequate and I go to write a new order, I’d like the patient to have the medicine as quickly as possible – and the patient would, too.”

 

At Hackensack, a similar system has helped cut the time it takes for a prescription to be filled in half, from two hours to one hour, and the turnaround time on non-medical orders such as lab tests has been reduced by 45 minutes.

 

The electronic system has also fostered a more team approach, said Terry Moore, RN, BSN, BC, administrative director of clinical informatics at Hackensack. “When the admission assessments were on paper, we started with a blank slate every single time. A patient could come in every week and we’d know the patient but we’d have to ask them the same questions, and every week they’d tell you they had an appendectomy in 1970. In some cases, a patient would visit several departments in the hospital on one day, and they’d all ask the same questions,” she said. “Now everyone has the same information, and when patients come back for a follow-up visit, we have the ability to pull certain information forward.”

 

Dr. Burns said that might seem small, but it’s important. “I think that gives the patient more confidence that the hospital knows what it’s doing,” he said. “There’s more of a collaborative feel within the hospital – a feel that we’re all working on the same team.”

 

Safety has improved as well, Dr. Burns added. Say, for instance, a doctor is alerted that one of her patients has checked into the hospital. From her office computer, the doctor might see a spike in temperature and order penicillin with a few keystrokes. But

if the patient told the nurse about a penicillin allergy when he checked in, that would be noted in the system, causing the computer to issue a “warning” screen recommending

a different antibiotic.

 

“Right then and there it’s already helping the doctor do the right thing,” Dr. Burns said.

 

 

But simply installing the technology isn’t enough. “A computer can’t practice medicine, so we’re not only buying hardware and software and setting it up but we’re supporting it and making it user friendly,” Dr. Burns said.

 

That starts with a comprehensive training effort, Moore said. “It’s a significant change for nurses, physicians and unit clerks to start using the system, for medication administration in particular,” she said. “They need to start depending completely on an online pharmacy. Prior to this, it was all on paper and they would fill out whatever they wanted to give a patient. Now they’re choosing medications from a computerized list generated by the pharmacy, so that’s a significant change.”

 

To help, the hospital brings in pharmacists to discuss the differences in the new system prior to launch. Additionally, for at least a week after implementation, two nurses familiar with the system are on hand at all times to answer questions. “We bombard them with support in the beginning, and then after about a week or so, they become more and more comfortable with it,” Moore said. “The same process happens with every department: first there’s a period where they’re adjusting, then they accept it, then they rely on it.”

 

Once a unit is up and running, the staff moves from a teaching to listening role, explained Benjamin Bordonaro, Hackensack’s director of IT. Doctors, nurses, pharmacists and other users are encouraged to make improvement suggestions, whether involving a clinical change, such as expanding the order set of drugs connected with a particular condition, or an operational change, such as asking to speed up the time it takes to change screens.

 

“We acknowledge them all and we address them all,” Bordonaro said, offering an example: “We just implemented a huge hardware upgrade and got down to sub-second screen flips.”

 

Among the most important factors to the program’s success has been strong support from the administration, said Lex Ferrauiola, Hackensack’s CIO. “We had to have the support and vision from the top that information technology was essential for the delivery of good patient care and safety. Without that vision, there was no way a medical center would think about investing the kind of money we did,” he said. “Very few organizations that have a strategic plan list information technology as a unique piece. We have nine strategic directions, and number seven is the implementation of IT.”