Thursday, September 1, 2005
Imagine a busy winter day in the emergency department at Yampa Valley Medical Center. The staff physician and support staff are already managing two cases of strained knees, a closed head injury and a laceration when a patient comes in with an unknown internal injury.
The physician suspects a bruised lung but needs definitive information to rule out a collapsed lung. The patient is sent to another part of the hospital for a CT scan, and the minute hand on the clock continues to move.
The physician needs to stay close to the other patients in the emergency room but feels an urgent pull to get the results of the CT scan as soon as possible
"In the past, when I had a trauma patient who was getting multiple scans, I might have run back and forth while managing the other patients," Dr. David Wilkinson said. "Now, I simply pull up the CT scan on the computer at my desk. In one or two (technology) generations, I'll be able to see it on my (handheld) PDA."
Wilkinson is talking about a new in-house computer system at YVMC that is changing the way employees in virtually every department access and share patient information. Hospital spokeswoman Christine McKelvie said that since early 2002, the hospital has invested about $3.5 million in the new patient information sharing network. The bill includes creating a wireless network and installing hardware for bedside access to the network.
"It's an enormous undertaking," McKelvie said. "It's the largest project we've taken on other than building the new medical center."
At the heart of the new system is customized software developed by a suburban Boston firm called Medical Information Technology Inc. More often, the company is referred to as Meditech.
Full implementation of the software will probably take years and before that is accomplished, upgrades will be tackled.
The goals for Meditech include a drastic reduction in the amount of paperwork that goes into the care of every patient visiting the hospital. Even more important is the time sensitive sharing of patient data, but only on a need-to-know basis. It means a physician beginning her daily rounds can sit down with a cup of coffee in front of a computer terminal and review patient histories without having to physically flip through charts that are inches thick. For example, the physician will know at a glance what the last set of vital signs recorded for that patient said.
At the same time, the hospital is training employees to use the computers, it's paying careful attention to ensure nurses don't lose track of patients' need for the personal touch, McKelvie said.
Meditech means a surgeon prepping for a procedure in day surgery, for example, won't have to wait for the results of a lab report to proceed - as soon as the report is complete, it will be accessible via a computer monitor on the wall in pre-op.
In the not-too-distant future, physicians working in offices away from the hospital will be able to do the same thing.
The illustration drawn from the hospital emergency department is a dramatic application of Meditech's capabilities, but day in and day out, its power is in streamlining the process of building up a file of information on each patient who comes into the hospital and seamlessly distributing the information to the care givers who need it.
"The ability to simultaneously share information is one of the key advantages we considered with Meditech," YVMC Medical Staff Coordinator Heather Skinner said.
She pulled up the complete file on a real patient who agreed to allow access to her information.
The patient has made a succession of visits to the hospital since suffering mild injuries in a car wreck in July. The patient was checked for evidence of whiplash in the Emergency Department and also had X-rays that revealed a swallowed tooth. The results of an electrocardiogram and CT scan also come up on her electronic chart.
The patient made an unrelated visit to the hospital for a severe bout with asthma.
She also had a procedure called an EGD, in which a tube was inserted into her throat and a tiny television camera allowed physicians to examine the lining of her esophagus.
The details of the patient's allergies, lab tests, prescription history and responses to medications are all available at a glance. In the era of increased attention being paid to patients' privacy rights, Meditech is able to limit the access to information depending upon the workstation and the role of the hospital worker assigned to it, McKelvie said. In cases where the work station is not authorized for certain types of information, Meditech screens access, Skinner said.
Skinner said before YVMC began implementing the Meditech system, it had fallen slightly behind other hospitals of its size in terms of its technological advancement. Already, it has leapt ahead of the curve, she said.