Electronic patient records…access to legacy data via Java-based browsers…systems that download and trend meter readings for diabetics…pen-based computer writing tablets…fingerprint imaging for patient admittance…real-time clinical data repositories….
This is not a list of emerging technologies for the next century, but instead a list of technologies currently in use at healthcare facilities from Portland, Ore., to Kowloon, Hong Kong. Each of these unique IT solutions was developed by partnerships of vendors and healthcare organizations that formed to fix specific problems related to record-keeping and patient care. Now, these six development teams are finalists in the 1998 Healthcare Information and Technology Systems (HITS) Award.
HITS, sponsored by the Henry Ford Health System, the National Managed Health Care Congress (NMHCC) and Healthcare Informatics, was created in 1992 to recognize healthcare organizations and vendors for ingenuity and innovation used in creating solutions to some of healthcare’s challenges. This year’s award--the sixth in history--will showcase vendor-organization partnerships in three areas: integrated delivery systems, outpatient organizations and inpatient organizations. Officials from NMHCC will announce the winners at their fall conference, Nov. 16-19 in Los Angeles.
Each of the finalists will have an opportunity before the winners are announced (on Nov. 17) to tell how their partnerships--and their products--came about. Here’s a preview of the stories:
Integrated delivery systems
375th Medical Group at Scott Air Force Base and Northrup Grumman
Air Force General Peter Hoffman got this project rolling after a transfer from a base in Alaska that used an electronic patient record system. When he arrived at Scott Air Force Base in Illinois, he approached officials at Northrup Grumman for help in developing a similar system. Although Northrup Grumman does work for the private sector, its main contracts are with the government. With this background in multiple systems and large volume (375th Medical Group boasts a 50 million-patient ambulatory medical system), Northrup Grumman was able to pull all the existing IT contracts and disparate systems together and develop the Clinical Integrated Workstation (CIW).
CIW--currently in version 1.0, with 2.0 close behind--creates online, real-time electronic medical records that replace paper records. "The problem with paper records is that they get lost," says Bobby Clark, project manager at Northrup Grumman. "This was a way to accommodate those records in an electronic format."
Unlike some electronic medical records on the market, this medical record system works at the point of care. Providers collect data on patients and enter it into the computer through graphical user interfaces that create medical charts on the computer screens, effectively creating an instantaneous patient historical record. Providers also have a number of different ways to enter data into the database. And once it is entered, the data is stored as write-once-read-many (WORM) documents.
Wesley Medical Center and Venture SystemSource
Like so many other integrated delivery systems, Wesley Medical Center in Hattiesburg, Miss., was overwhelmed with data buried in a variety of legacy systems. The cost to upgrade or replace each of these systems would be debilitating to the medical center. That’s why Debbie McMahan, MIS director, turned to Venture SystemSource--a company interested in creating a Java-based system.
The project started when officials from Venture and Wesley began brainstorming how to use the latest and greatest technology. "Our part was to let them see how a hospital functions and what our needs were," McMahan says. "They wanted to get into [the Java market] to fulfill needs they saw in other markets."
The result of this brainstorming was MEDIWEB, a system that uses browsers and other Internet technologies. The system allows users to sign on only once and access data from legacy systems throughout the enterprise. MEDIWEB accesses financial, billing, demographic and clinical data, including pharmacy and drug information, meds and lab results.
Outpatient organizations
Beverly Phillipson, MD, PC, and NuMedics, Inc.
After getting diagnosed with diabetes in 1993, businessman and computer scientist, Kazi Ahmed, set out to create a computer program to help keep track of his daily meter readings of glucose levels. The fruit of his labors was a patient-oriented program that allows diabetics to store their digital meter readings instead of recording them in handwritten log books.
Following some encouragement from area physicians (including his own), Ahmed began working on another system that specialists could use to keep up-to-date electronic medical records and download digital meter readings to medical records to follow trends in patients’ conditions. In 1997, Ahmed’s company, NuMedics, Beaverton, Ore., put this product, Clinipro 1.0, on the market.
Beverly Phillipson, MD, an endocrinologist in private practice in Portland, Ore., was one of the physicians Ahmed worked closely with during the development of Clinipro. Phillipson runs a one-physician clinic that is completely networked with 11 computers throughout the office, including a computer in each of three exam rooms.
This clinic uses all three of the modules NuMedics makes available in Clinipro: email, online appointment scheduling and the disease management and an electronic patient record system.
Baptist Hospital Outpatient Department and Baptist University, Computer Science
To automate clinical paper workflow and simplify document generation (such as bills, prescriptions, etc.) in an outpatient clinic, Hong Kong’s Baptist Hospital commissioned its own Baptist University to create a computer-based patient record system using a pen-based computer tablet. The LCD writing tablet, created by NotaPenna Limited, today is connected to Baptist’s Novell-based LAN PCs.
According to Stephen Chan, professor of computer science at Baptist University and one of the software’s creators, physicians and nurses are using the system to increase their time with patients and decrease their time with paperwork.
Although neither organization has fully investigated the project’s return on investment, Chan says the system has the potential to dramatically increase providers’ overall productivity and success. First of all, writing tablets are set up in each of the clinic’s 12 consultation rooms. Also, the system is integrated with the hospital’s database. When a patient registers for a visit, the physician is able to pick up historical patient data, including physicians’ notes, tests ordered and X-rays or other images received. At the end of the visit, the physician can electronically order lab tests, prescriptions and even bills.
Though getting complete physician buy-in remains a challenge, Chan says the pen-based system is less overwhelming than other systems because it looks like and works in a manner similar to traditional paper charts.
Inpatient organizations
La Porte Hospital and Health Services and NEC Technologies, Inc.
A few years ago, an information services employee at La Porte Hospital in La Porte, Ind., suggested to a group of peers at an industry conference that fingerprint identification would be a great way to register patients. Carolyn Shebel, a former courtroom stenographer, got the opportunity to present her idea to a task force set up to investigate the idea of express registration at the hospital.
Shebel presented a convincing case to skeptics at La Porte, and though she is no longer with the organization, fingerprint imaging is now a way of life at this 227-bed facility.
The system was created by NEC Technologies--veterans to the law enforcement industry where fingerprint imaging was born. NEC officials began the La Porte project--their first in healthcare--by installing an off-the-shelf fingerprinting system and tailoring it to hospital’s unique requirements. Today, the system uses biometric technology to store, search for and match patients to their medical records. All this is possible because of an interface set up between the NEC system and the hospital’s patient record system from Shared Medical Systems.
St. Vincent’s Hospital and HBOC
Three years ago, officials at St. Vincent’s Hospital began addressing the best way to bring value and improved patient care to the hospital. The three areas they looked at were: quality of care, cost-effectiveness and patient satisfaction. Together, these goals led St. Vincent’s officials to the solution of a clinical data repository.
According to Susan Jennings, the hospital’s director of outcomes management, it was around this same time that hospital officials heard about HBOC’s vision for the complete continuum of care. Thus, as a user of HBOC products, it was a natural progression to begin working closely with the vendor to tailor its Pathways Coordinated Care product to the hospital’s unique needs.
Today, 115 of the hospital’s physicians are using Pathways to access a variety of data from a variety of systems for 75 percent of the hospital’s admissions. Further, the system allows providers to use numeric results and observations to trend outcomes in tabular or graphical formats that cross patient encounters.
The real winner
It takes a lot more than a well-known name and a fancy product to solve some of healthcare’s more elusive problems. Creative ideas and the will to make them concrete also are important to any winning combination.
Still, if there’s one thing that managed care has taught, it’s that teamwork is the most important ingredient when it comes to improving patient care. That’s the message the annual HITS Award is passing along: Vendors and healthcare organizations are all in this together. In the end, the true winner is the patient.
Lisa Paul is managing editor at Healthcare Informatics.
