In the not-too-distant future, Columbia Healthcare Corp.'s physicians and nurses will be able to order tests, check a patient's medical history and read lab results on a hand-held computer, about the size of a TV remote control.
With an orderly precision much like its strategy to build market share in certain cities, the nation's largest investor-owned hospital chain expects to gain a competitive edge by methodically computerizing the work of its managers, nurses and physicians.
Columbia has drawn a fairly visible blueprint for gaining market share by building networks of physicians and hospitals. What's not as well known is that the Louisville, Ky.-based company is taking an aggressive tack in the information arms race in which hospitals soon will be competing.
"We want to outpace what our competition is doing," said David Vandewater, Columbia's chief operating officer. By making patient information quick and accessible, Columbia can make it more convenient for physicians to practice at its hospitals and keep closer track of costs, he said.
Columbia invested $13 million in a data center in Fort Worth, Texas, in January 1992. One-by-one, all of Columbia's 94 hospitals are being tied into the system for financial and clinical information.
Darrel J. Lapierre, Columbia's vice president of healthcare system services, declined to say how much the company is spending on information systems technology. However, he said, it's less than 1% of the company's $5 billion in annual revenues. Mr. Lapierre has a 90-member staff that provides system installation and support.
One of the key advantages touted in Columbia's merger with Galen and its pending merger with Hospital Corpo ration of America is savings in overhead and vendor dis counts. Columbia and HCA executives have said the merger will save $130 million a year, about half of which will come in medical supply savings.
In addition, through volume buying and shared computer resources, Columbia can re-engineer its information systems more economically than most hospitals, Columbia executives say.
For example, Columbia is now equipping all of its hospitals with a patient information system with optical scanning19
capabilities that can be accessed by physicians at the hospital or in their offices. Thirty-three Columbia hospitals are now on line, and that number is expected to double by the end of the year.
"A 300-bed hospital that would put this system in with all of these functions would spend $3.5 million," Mr. Lapierre said. "We do it for less than $600,000."
Columbia's hospitals already have an executive-support system that provides financial information, including data on physicians and the charges they create, payroll data by department, and information on payers.
Some 2,000 physicians-400 of them in their offices or homes-are using the new patient information system to check on their patients in Columbia hospitals. Physicians can use the system on their own personal computers through a modem. The software is provided free by Columbia.
The system contains a wide variety of information, such as emergency department visits, hospital stays, drug interactions, the most recent results of a blood glucose test and the terms of a patient's "living will." The system also has cost information for various drugs so that a physician knows if he's ordering the most or least expensive prescription.
"I couldn't pull up paper records and get the information this quickly," Mr. Lapierre said. In the past, when a physician needed records from the hospital, they had to order them and have them sent over to the office.
For example, this month, four Columbia hospitals in southwestern Florida and its facilities in El Paso, Texas, will begin using a new optical scanning component that allows a physician to look at the actual medical record, such as an ECG strip, rather than a printed report about the record's results.
An information network with patient information is especially valuable in markets such as Miami, where Columbia will have 14 hospitals and a 25% market share when the HCA merger is completed. "Because we're market-based, a physician can take a single look at a patient regardless of the institution they went to," Mr. Lapierre said.
That's good news for physicians and patients because they won't have to go through the usual battery of medical history questions.
Cedars Medical Center in Miami went "live" with the system in December, and by the end of March, Columbia Continued on p. 25
hand-held, point-of-care computer.
Continued from p. 19plans to have 100 physicians on line in their offices. "It's an excellent marketing tool," Mr. Lapierre said.
By 1995, Columbia hopes to begin piloting a hand-held computer for physicians.
A similar hand-held version, developed by Westwood, Mass.-based Medical Information Technology and Data General, is being used by nurses in some Columbia facilities.
The 11-ounce hand-held units, which run on AA batteries, cost about $500 each and contain information on 15 patients. Because of their small size, nurses can hold the unit with one hand and take vital signs with their other. When nurses are done with their rounds, they can download it into the main computer.
Nurses in Columbia's hospitals in Fort Myers, Fla., and Houston will be trained to use the computers during the first quarter of 1994. Another 12 to 16 hospitals will begin using them by the end of the year.-Sandy Lutz