For two years, Memorial Healthcare System has waded deeper and deeper into the waters of clinical information technology.
All four hospitals of the Hollywood, Fla.-based not-for-profit organization have installed electronic medical-records systems in their emergency departments. All four -- three acute-care facilities and a children's hospital -- also have computerized their pharmacy and scheduling systems.
Last year, the hospitals completed a rollout of a picture archiving and communication system/radiology information system, or PACS/RIS. This year, Memorial will close the loop by adding a home-grown Web interface to allow physicians to access the PACS/RIS systems serving all of their hospitals from their offices or homes.
But on March 17, Memorial Healthcare will open a fifth hospital -- and plunge into the deep end of the IT pool. The new $143 million Memorial Hospital Miramar (Fla.) was planned and constructed as a wireless and nearly paperless facility.
Miramar will have 100 licensed beds, 28 observation beds, and all the electronic goodies of its four sister facilities, plus a whole lot more, according to Bob Reese, Memorial Healthcare's chief information officer.
Miramar will be wireless wall-to-wall, with two separate systems, one for clinical devices used by hospital personnel and the other for patients and visitors to access the Internet in the hospital's public areas.
"A member of the community can come in with a wireless device and get on the Internet throughout the facility," Reese says.
In addition, patients will be tracked throughout the hospital via wireless radio-frequency identification devices clipped to their hospital gowns. Care providers who want to be readily located can clip on a device, too.
A wireless bar-coding system will be used to check drugs at the bedside. In addition to computer terminals at nursing stations and other areas throughout the hospital, each patient room will have a hard-wired computer terminal on which the entire patient medical record can be pulled up by physicians or other appropriate providers.
Wireless-enabled laptops can call up the records within the hospital, too, while a more limited set of patient data will be accessible via wireless personal digital assistants.
The hospital is vigorously testing the systems and documenting hundreds of hypothetical patient-care scenarios to ensure all will be ready for opening day, says Stanley Marks, chief medical officer and chairman of the medical informatics committee at Memorial Healthcare.
At the four older hospitals, "Our philosophy has been to roll out (IT) in a slow, methodical fashion," Marks says. "I think when you deal with a new hospital, you almost don't have a choice. Essentially, you're starting from scratch. You have no patients, and on ground zero you open with all new staff.
"When you have that scenario, it's very hard to do things in a methodical slow fashion, because you're bringing all your systems up at the same time. It's risky, but you have an opportunity to mitigate those risks," Marks says. "We've had an opportunity to do a lot of training. And the hospital isn't going to open up with all of its beds full. Practically speaking, it will open up unit by unit."
Having several pieces of the Miramar system already online at the other hospitals has given Marks and his medical informatics committee the chance to develop training materials that are being used to teach Miramar's staff. In addition, only emergency room physicians will be using the electronic documentation and order-entry systems at Miramar when it opens, Marks says.
"Our plan is to move forward with physician-charting and order entry in early 2006," he says. "Our strategy is to get the pharmacy, bar-coding (and) all dictation reports available within the computer system. That way the physician is fully engaged already in the computer. Once we get them engaged, the plan is to roll out (CPOE) unit by unit."
"The physicians are looking to get physician order entry," Marks says. "They have criticized me for not pushing it sooner. But I think this strategy will pay off. I don't want to duplicate the mistakes others have made."
Over the next two years, Memorial Health-care plans to roll out the same clinical IT components launched at Miramar at its other hospitals, so lessons learned at the new facility will be shared at those facilities, Marks says. The total IT tab for all five hospitals will run "probably somewhere in the $40 million range over five years," he says.
Memorial Healthcare performed a return-on-investment analysis for the IT system at Miramar, but Marks says, "The thing that really sold our board was this was the right thing to do in terms of patient safety.
"I believe over the next four or five years, these will be the cost of doing business," Marks says. "(Information technology) has to be used if you want to practice medicine in the 21st century."
This article originally appeared in the Feb. 14, 2005 issue of Modern Healthcare.