Dr. John Halamka, the Harvard physician, operates the information systems that link the medical records of all patients in a 21-hospital system in the Boston area. We watched as he connected into his system, and the image from his computer was projected on a screen. He showed us how a doctor can sit at a computer anywhere and, through the internet, see the list of his hospitalized patients. Some patient names have flags indicating new test results or highlighting abnormal tests that need the doctor’s attention. The physician can click on each patient name and see each patient’s information. The doctor can easily change a patient’s medications or write notes in the chart, all from the computer. The system automatically reminds the doctor of care standards and potential drug interactions.
Dr. Halamka showed us the future.
At most hospitals patient information is still very much a paper process. Hospitals may have advanced clinical equipment, but when it comes to information management, most of us still use paper technologies that have more in common with the 19th than the 21st Century.
Even when we have computerized information, it is usually in stand-alone systems that are not easily linked. For example, the CGH radiology system is separate from the CGH pharmacy system, and each is separate from the CGH patient registration system. With isolated systems, it is very difficult for doctors to check on their patients. With isolated systems, patient information and identification numbers are entered manually on multiple occasions, increasing the opportunity for error. To review patient information, CGH doctors currently use multiple passwords and different codes to get into these separate systems, each with its own report on the same patient.
Two weeks ago President Bush was in Ohio[1] to highlight health care information technology as “essential to improving America's health care system.” The White House news release said that, although information technology has transformed industry, hospitals have yet to realize the full benefits of the digital age. As a result, it said there are
serious concerns about high costs, avoidable medical errors, administrative inefficiencies, and poor coordination – all of which are closely connected to the failure to incorporate health information technology into our health care system.CGH is about to take one giant step into the next generation of information technology. Next week our Board of Directors will review new technology to link our stand-alone systems. This will be a major advance, and the changes in the coming months and years will affect many areas of our hospital.
CGH was the first hospital in Syracuse (and one of the first nationwide) to implement a pharmacy robot some ten years ago. Since then we’ve seen the addition of computerized drug-dispensing units in patient care areas, new x-ray and pharmacy systems, a speech-recognition dictation system – and this year we will add a new surgery system.
What is the new technology being planned? CGH will begin to develop an electronic medical record, and we will install a new “portal” to allow physicians to see on computer the list of their hospitalized patients. CGH doctors, using a single password and code, will be able to see patient test results, to readily identify abnormal values, and to enter orders directly into the system, even from their offices or homes. When these changes are complete, doctors on our medical staff will be able to do many of the things we saw demonstrated last May.
Linking CGH’s stand-alone systems through the “portal” will go a long way to making patient information more available and easier to use. And the true beneficiaries will be our patients. These systems will improve patient safety because they reduce the risk of misidentification and the risk of medication error.[2]
President Bush has set a ten-year goal to assure that most Americans have electronic health records. The electronic records would be able to share information privately and securely among health care providers. There’s a lot of work to achieve that national goal. Even the Boston system we saw in demonstration links providers within a single hospital system and cannot communicate with outside doctors or hospitals.
The review with our Board next week will be a first step. Acquiring these systems represents a commitment of millions of dollars over several years, a significant investment for our hospital.
The new technology will represent more than a “portal” for physicians and additional safety protection for patients. The new technology will be CGH’s passport to the future: when the nation is ready to share medical information among hospitals and doctors as the President has proposed, CGH will be prepared.
[1] On January 27, 2005, the President appeared at the Cleveland Clinic.
[2] “CPOE systems can be remarkably effective in reducing the rate of serious medications errors,” according to The Leapfrog Group, which is made up of more than 160 companies that buy health care services. The Leapfrog Group seeks to reduce preventable medical mistakes and improve the quality.
