The decision late last month by HCA and Atlanta's Promina Health System to join the Leapfrog Group in its effort to reduce medical errors and improve the quality of care in hospitals underscores the importance of the information technology revolution sweeping through the American healthcare industry.
This revolution is responding to the basic problem that medical knowledge, skills, drugs and devices have advanced faster than our ability to deliver them to patients safely, effectively and efficiently. That lesson was made shockingly clear by the now-famous reports from the Institute of Medicine. Both studies outlined how paper-based clinical and administrative procedures-many of which have been in place and practiced for decades throughout our provider facilities-are causing inefficiency, adding cost and most alarmingly contributing to preventable medical errors that are estimated to kill from 44,000 to 98,000 people each year. Even using the lower figure, the lost lives equate to more than one World Trade Center disaster every month.
The leading cause of death involves adverse drug events because of the wrong drug or wrong dosage being prescribed, a problem the Leapfrog Group has tried to address by requiring an electronic system for medication orders. But there are additional problems involving unsafe hospital procedures and the fact that clinicians-no matter how intelligent, dedicated and specialized-are unable to stay current and retain all the information needed for sound evidence-based medical practice.
By itself, simply using more information technology is not the answer. An inefficient manual process should not simply be made more efficient through technology-we should not automatically pave an old cow path. We can only bridge this quality chasm if our healthcare providers are willing to transform their clinical and business processes and use technology as a tool to decide if new paths should be created.
Healthcare organizations such as Kaiser Permanente, Good Samaritan Regional Medical Center in Phoenix, Montefiore Medical Center in New York, Florida Hospital in Orlando and University of North Carolina Hospitals in Chapel Hill are among leading providers rethinking how to better ensure patient care and safety. The changes they have made or are considering implementing revolve around creating an integrated information technology infrastructure that collects and integrates appropriate patient data in digital form and then makes it available at the point of care.
Electronic medical records are at the heart of any electronic clinical information system. Unlike traditional paper-based patient charts, electronic medical records would not be misplaced, and the appropriate and current data is available on demand by the family physician, hospital-based clinicians and even the patient's pharmacy. Once the patient medical data is digitized, "intelligent software" gives the physician clinical decision support to avoid treatment or medical errors such as transposing a decimal point in a prescription or prescribing a drug that will adversely react with a drug previously prescribed by another physician.
Such a system is being implemented at Kaiser's operations in nine states. To improve patient care and quality, Kaiser wanted to use a technologically advanced but cost-effective solution to establish an exchange and accessibility system of medical information and clinical data in a consistent, cross-referenced form that would be available at the point of care. This led to the building of the company's nationwide clinical information system.
The Kaiser system integrates multiple disparate digital systems and devices. It provides an electronic medical record that the clinician can update instantly, allowing the ability to track and warehouse patient clinical records, in addition to ordering and scheduling health services. The data stored in the repository also can be mined to do patient outcome analyses. This system has enabled business transformation, improved customer service and improved quality of care through best practices.
Florida Hospital, one of the largest not-for-profit hospitals in the country, is installing a Web-based clinical information system that enables physicians to see current clinical data and laboratory results. Physicians can view a patient's clinical summary, which includes three days' worth of information showing where a patient was yesterday, status and results for today, and anything ordered for tomorrow. Physicians also can see current data on what medications patients are taking.
Another exciting development is computerized physician order entry, which uses various types of handheld wireless devices to view, assess and enter new clinical data, often at the patient's bedside. The data, including any drug prescriptions, are automatically entered into the electronic medical record. Again, intelligent software can recommend a treatment protocol or warn against any potential adverse reactions in a proposed treatment.
Payers also are using the Web to help their customers. By summer's end, eight Blue Shield and Blue Cross plans will have adopted the National Account Service Co. Web site, called My Health Care Benefits Online. The site will enable more than 1 million plan members to track the status of their healthcare claims, eligibility, deductibles and benefit information.
All of these advances are helping to create an electronic infrastructure that enables collaborative care among healthcare providers with vastly increased patient safety and efficiency. It's happening now and we will all be healthier because of it.