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Article Last Updated: 9/05/2005 11:46 PM
E-liminating Errors
Computers improve communication and care, reduce medical mistakes
By Carey Hamilton
The Salt Lake Tribune
Salt Lake Tribune
Seeing a bedside computer at LDS Hospital warn that a patient was allergic
to a drug, Montye Conlan of Florida was impressed by the computer's
power to improve care.
"I was struck by the implication that this system . . . would have
prevented many of the errors that have occurred in the geriatric care
of my own parents," she said after touring the Salt Lake City hospital.
"Specialists who are not taking a team approach and are unable to communicate, through technology or otherwise, may have at times prolonged hospital stays," she said, "and triggered adverse events for them."
Conlan visited Utah as one of 14 members of the Citizens' Health Care Working Group, charged by Congress with traveling the country to gather ideas for improving U.S. health care, access to insurance and lowering medical costs.
At LDS Hospital, they witnessed an emerging national trend seen as crucial: the use of computers and technology to improve health care and reduce medical errors, believed to kill up to 100,000 Americans each year.
How can informatics - the effective organization, analysis and use of information - cut costs and save lives?
l By standardizing care. With richer Medicare reimbursement as an incentive, the federal government is pushing hospitals to track basic care, such as: Did heart attack patients receive aspirin within 24 hours of arrival?
l By personalizing care. Turning your paper file into an electronic medical record will allow computers to help guide your care, such as alerting doctors when a new prescription might cause a negative reaction with your existing medications.
l By improved monitoring. At LDS Hospital, the bedside computers remind nurses of the times and precise dosages for giving medicine.
If a patient has a problem with a ventilator, a red and black flashing warning appears on all the computer screens in the unit.
"It's very effective because there's not a chance that someone, somewhere, is not looking at a computer," Nancy Nelson explained to Conlan, who has multiple sclerosis and is a dual Medicare and Medicaid beneficiary, and other citizens group members during their July visit.
Informatics campaign: The group was invited to LDS Hospital by Brent James, a Salt Lake City doctor and vice president of Intermountain Health Care (IHC), which is considered a national leader in informatics.
The hospital's staff also has developed an antibiotic assistance program. After testing blood, it displays a patient's white cell count, checks for allergies, recommends dosage and the best drug, and displays costs of different drugs.
The information it provides used to take doctors about a half an hour to get on paper. Antibiotic costs have dropped 60 percent since the program was developed.
"The length of stays have been shortened because of fewer mistakes," said Scott Evans, senior medical informaticist at LDS Hospital.
One of the newest technological advances is glucose screening on the computers. After blood is drawn and tested, the computer monitors a glucose drip.
"It's very important to keep the patient's glucose level between 80 and 110," Nelson said. "Stress, just lying in a hospital bed and other drugs can cause sugar to go out of whack."
Citizens group member Christine Wright of Sioux Falls, S.D., has seen profound changes during her 30 years in nursing.
"From my visit to Utah, I would say that we have initial proof where IT [information technology] can assist in health care, reduce costs, length of stay and still deliver quality and appropriate care to the customer," she said.
"True, there is a high cost of initial investment," she said, "but LDS has done studies showing that within just a few years what their return on investment is."
Randy Johnson, chairman of the citizens group and a Motorola executive, said the Salt Lake City trip will help members write their Health Report to the American People, scheduled for release next year.
"We're really interested in what LDS Hospital is doing with technology to improve efficiency and patient safety," he said.
Sending medical history to cyberspace: As U.S. Secretary of Health and Human Services, former Utah Gov. Mike Leavitt is leading the country's efforts to move to electronic medical records.
"The goal is to make the medical clipboard a thing of the past," Leavitt said during a recent trip to St. George. "We will make it happen."
Leavitt said he was frustrated during a recent outpatient procedure, when he had to repeat his health information seven times. He says electronic records have four major benefits: They lower costs, improve quality, result in fewer medical mistakes and are less hassle.
He will lead a national commission, to be named this fall, that will develop national rules to standardize electronic medical records and make them secure. Leavitt said Utahns are among the candidates.
"Utah is perceived as being very advanced in e-IT [electronic information technology]," he said. "IHC is always cited as a premiere example."
In February, IHC and GE Healthcare announced a 10-year, $100-million
partnership to develop medical software to create electronic medical
records and improve patient care.
Laura Polacheck, associate state director with AARP, agrees electronic
records should improve quality and save lives, but adds they also raise
concerns about patient privacy.
"There's a lot of damage that can be done if your health information
is exposed," she said. "There's a delicate balance between
making sure the information released is accurate and only seen by people
who really need to have access to it."
One particular area of worry: scamsters who access patient records and
market bogus products or health plans to them.
"There can certainly be abuses, as we've seen with the financial sector" with some credit card companies and banks, Polacheck added. "We'd like to see systems tailored for the uses they were intended for. We will keep an eye out for that."
What is the citizens' group studying?
* What health care benefits and services should be provided?
* How does the American public want health care delivered?
* How should health care coverage be financed?
* What trade-offs are the American public willing to make in either
benefits or financing to ensure access to affordable, quality health
care coverage and services?
For more information, visit http://www.citizenshealthcare.gov.
What is an electronic medical record?
A digital medical history, it could include your age, weight, medical conditions, prescriptions, immunizations and results of laboratory tests. Providers could access it securely through the Internet no matter where you are seeking care. President Bush wants most Americans to have electronic health records within 10 years.
What are the expected benefits?
Medical errors will be cut and the quality of health care will improve as your electronic record is combined with new information technology, experts predict. For example: If a proposed new prescription would react poorly with your existing medications, your doctor or hospital staff would be alerted.
Paperwork and costs would be reduced. Patients would not have to repeatedly supply basic information or undergo duplicative tests.
What's happening now?
The American Health Information Community, a national commission of
up to 17 members, is being appointed to develop national standards for
electronic medical records. The goal: make records from different sources
interoperable and secure.
Health and Human Services Secretary Mike Leavitt will lead the group;
other members will be announced this fall. Leavitt says there are Utah
candidates.
The department is also reviewing proposals from companies on how to standardize information in the records, create an Internet-based nationwide health information exchange and protect patient privacy.
Any potential problems?
Patient advocates warn security is crucial, pointing to leaks of financial data and hackers. They also want records tailored to protect privacy: for example, a billing clerk would see only information related to charges, not a patient's full medical history.
More information is available at http://www.hhs.gov/healthit.
-- Source: U.S. Department of Health and Human Services, Tribune interviews