Clinical information to GE Medical Systems had always meant the kind of data coming out of patient monitoring equipment or captured as diagnostic images such as MRI or CT scans. But now the medical unit of corporate giant General Electric is investing hundreds of millions of dollars to bathe the clinical process in information technology.
Leaving the automation of patient admissions and discharges to established healthcare software companies, GE Medical's year-old information technologies division will concentrate on improving data access and workflow in high-intensity clinical areas of a hospital, says Greg Lucier, president and chief executive officer of the IT unit.
Areas such as emergency, intensive care, surgery and cardiology rack up the most operating expense and harbor the highest risks in a healthcare facility, and timely information access can reduce that risk and expense, Lucier says.
"We want to use information technology to change clinical workflow," he says. "When you change the workflow, you end up having enough people to do the job in the right way."
GE Medical's marketing pitch to the healthcare industry follows along the same lines as Siemens' in emphasizing the importance of coordinating the smooth delivery of care using computer capabilities. Both companies also draw on experience in monitoring patients for vital signs and in capturing and electronically distributing diagnostic images.
Milwaukee-based GE Medical recently expanded its breadth of software products, acquiring the means last year to automate and analyze clinical data from patient encounters and to computerize radiologists' interpretations of digitized images.
Additionally, the information technologies unit wants to tackle the organizational change that goes with implementing clinical IT, promoting a consulting approach in which healthcare organizations first develop a case for change and map it to the current workflow before getting into selection of vendors and specific technology.
Formed in August 2000, the IT business unit combines the new clinical information systems business with existing patient monitoring, radiology, cardiology and change management units. Collectively the units took in $1 billion in revenue last year, Lucier says.
With 4,000 people committed to the strategy and $150 million applied to research and development this year, the reorganization is "totally devoted to connecting doctors to information to patients," Lucier says.
Impact of information from imaging
Unlike most of the companies competing for clinical information technology business, GE Medical's customer base is concentrated in diagnostic image management.
More than 300 healthcare facilities use a GE Medical information system that records, stores and distributes diagnostic images across the organization. Known as a picture archiving and communications system, or PACS, the computer application is intended to expedite the care process by reducing turnaround time and making images available to more than one clinician simultaneously.
For healthcare managers, a PACS provides the potential not just for service improvement but for a lower unit cost of imaging studies and the ability to compete for market share in a wide geographic area.
For example, Cincinnati Children's Hospital reduced its turnaround for radiology results reporting to an average of two hours in 2001 from an average of nearly 40 hours in 1999, says Neil Johnson, M.D., a pediatric radiologist and chief medical adviser in clinical informatics at the 350-bed pediatric teaching facility.
Once the PACS became operational at the hospital and at seven outpatient centers in the metropolitan area, volume of radiology exams rose 27% in one year, to 145,000 from 114,000, which Johnson attributes partly to new business from pediatricians throughout the region who were attracted by the quick turnaround.
Cincinnati Children's has promoted a guarantee that an urgent reading will take an hour or less from the end of a radiology procedure to final sign-off by a radiologist and communication of the results to the attending physician, he says. Combined with process changes, the radiology department initially delivered on the promise 80% of the time, and now its radiologists are held to a 95% success rate. "Without PACS we couldn't have offered that guarantee," Johnson says.
The current routine is an order-of-magnitude difference from the previous dependence on using pickup trucks to get films back and forth between the central radiology department and the seven outlying outpatient facilities, Johnson says.
Among other business benefits, the cost of a study has dropped to $37 from $42. And by focusing on service, the hospital has prompted pediatricians at the outskirts of its service area to send children to the outpatient clinics instead of to nearby adult hospitals where they sit around longer waiting for their turn-and longer before getting some word about a diagnosis. "What we claim we're good at is the medical report," Johnson says. "The image is just a tool."
Just getting urgent films interpreted and communicated on the same day they're taken is a blessing for parents who need to know, for example, if they have to take the next day off from work, Johnson says.
A clinical path
Oddly, computer systems could not combine radiology images and interpretation on the same screen a few years ago because the industry technical standards developed for each activity were not compatible. That has bred inefficiency because of the manual intervention it takes to reconcile information from two different information systems, says Vishal Wanchoo, vice president and general manager of radiology systems for the GE Medical IT division.
Spurred by an integration initiative sponsored by the Healthcare Information and Management Systems Society and the Radiological Society of North America, GE Medical plans to unveil an integrated radiology information and imaging system later this month at the annual RSNA conference in Chicago, Wanchoo says.
Other companies marketing clinical information services, including Siemens, IDX Systems Corp. and Cerner Corp., are scrambling to acquire or upgrade PACS capabilities and integrate them into their radiology information systems. Meanwhile, GE Medical is crossing into the clinical IT sector with an initiative to supply "information moving as fast as the patient through the (provider) system," says Vik Kheterpal, M.D., vice president and general manager of clinical information systems and former president of Ann Arbor, Mich.-based SEC, a clinical software company GE Medical purchased last year.
Although most hospitals have administration and scheduling information systems and have automated lab and pharmacy information, "largely untouched is all the stuff near the patient," he says. The SEC-derived applications integrate data from areas that depend on patient data and physician order management to be effective: emergency, operating rooms, critical-care and intensive-care units, obstetrics and neonatal ICUs, perioperative-care units, radiology and cardiology.
The captured and presented clinical information also enters into workflow management. The emergency-department application tracks patients and care stations opening up in the ER to monitor whether people are waiting unnecessarily, Kheterpal says.
The operating-room information system is set up for the day of surgery to go well by tracking what needs to be done beforehand. For instance, if a surgeon hasn't read a result from the cardiac catheterization lab 72 hours before a planned operation, an alert brings it to a manager's attention, Kheterpal says.
The clinical system is operating at five provider organizations representing 12 facilities, including the University of Michigan's medical center and the four facilities of Community Hospitals Indianapolis.