Not long ago, hospital technology consisted of diagnostic tools used by physicians to evaluate patients. Whether CAT scans or laparoscopic devices, cutting-edge technologies were quickly adopted and rendered mainstream by clinicians bent on less invasive and more effective ways to treat their patients. Now, innovative technologies such as surgical robotics and 3D guided imagery continue to push the boundaries of medical science and care today.
Physicians are generally more than willing to accept IT developments that enhance diagnostic sophistication and accuracy, treating such changes as welcome improvements. But as patient outcomes, data security, and healthcare costs increasingly dominate the national debate, hospital executives and government leaders are capitalizing on advancements in information technology for a different kind of diagnostic tool: the automation of data collection and mining, recordkeeping, and administration at the nation's healthcare institutions. In addition to improving administrative efficiency, healthcare professionals look to this use of information technology for a critically important end: the transformation of patient care.
One of the first steps in the process is the implementation of electronic health records. According to Dee Cantrell, RN, BSN, CP, chief information officer for Emory Healthcare and an associate director of enterprise clinical informatics for Emory University's Woodruff Health Sciences Center, electronic medical records (EMR) can provide secure and ubiquitous data capture and access to comprehensive, longitudinal patient care information.
Cantrell notes that EMR allows for a safer, more holistic approach to care, as it assists in the management of information that must go into clinical decision-making. In 2002, Emory Healthcare made a huge leap forward in data storage and access by adopting virtualization technology, a software technology that cuts down on server sprawl and compartmentalization by reducing the number of physical machines at an institution in favor of virtual machines. Virtual machines not only consolidate servers and data, but also represent a greener approach to computing through reduced power demands. The electronic medical records at Emory Healthcare now allow clinicians to retrieve a patient's information via any device from any place throughout the healthcare enterprise, as well as from any remote location. The data does not reside directly on the laptop or on other computer devices because all information is streamed, not downloaded, to the devices from the secured virtualized pool of servers and storage.
Given federal regulations passed in 1996 creating national standards for the protection of private health information (The Health Insurance Portability and Accountability Act, or HIPAA), patient records must remain private and confidential. According to Cantrell, full virtualization provides the platform to meet this essential requirement. She adds that virtualization technology has allowed Emory Healthcare to slash hardware and administration costs-a price tag that can be enormous for large healthcare institutions that must store and allow secure access to huge volumes of data, sharing it across various parts of the hospital. Long-term cost savings are also enhanced by the reduction of administration and personnel needed to maintain the system.
While the initial implementation of electronic health record systems may represent multi-million dollar outlays for hospitals and health facilities, the benefits appear to be immediate, says Cantrell. And as U.S. President Obama and his administration look to push EMR adoption in the medical setting, an increasing number of institutions will be required to incorporate more enabling technologies, which combine and integrate hardware and software components to render once impossible or impractical automated processes possible. The U.S. government's stimulus spending includes funding for healthcare technologies, specifically in the form of Medicare and Medicaid incentives for clinicians and institutions to use specific or certified electronic medical record systems.
But the benefits of EMR aren't merely monetary. Physicians can use electronic health records for entering medical orders, placing prescription requests, and documenting their care of patients via an online interface-saving valuable time compared to the older, written chart system. All caregivers can access it, thus making patient care quite seamless, adds Cantrell.
Of course, administrative and medical staff are sometimes slow to embrace the initial changeover to new systems of data storage and retrieval. And because technology-as well as patient needs-seldom stand still, implementation is by necessity evolutionary. It's a dynamic thing, and the physicians and various caregivers do need to be a part of the process, notes Cantrell. My job as CIO is to support the providers, and on the IT team I do have IT professionals as well as physician, nurse, and many other clinical care provider advisors who are a critical component of success. There has to be active engagement by all the care team providers, or no matter how good the technology, it simply won't be embraced.
Richard Metters, associate professor of operations management at Emory University's Goizueta Business School, says physician involvement in development, acceptance, and rollout of new technology is essential in making large-scale changes work. And, he adds, the buy-in is critical to making long-term process improvements sustainable. Cantrell adds, Certainly, it's a continuous journey, as medicine and technology move ahead. There has to be a way to monitor and improve what's in place. She recommends a feedback system, with online email responses or even a phone-in hotline, as Emory Healthcare has employed. We also conduct a daily conference call bridge line in real time to get feedback and tips from the staff and doctors as we have deployed computerized provider order entry, she says.
Bridging the gap between the medical staff and IT professionals may be one way to ease some of the transition. But Metters and Cantrell acknowledge that some physicians and other patient caregivers may still consider new IT implementation a low priority in a day where they are already pressed for time and focused on patient care. Says Cantrell, In many ways, the technology is the easiest piece of the puzzle. Change management can be more difficult. Human dynamics and ingrained behaviors can be hard to manage, she admits.
Cantrell recommends establishing set expectations in any IT rollout. It has to be a transformative process, and it takes attention, focus, training, communication, and accountability to get the team onboard. Understanding the benefits of IT implementation is the first step to managing the apprehension that inevitability comes with change. Cantrell suggests that those in charge make it clear that the new systems will improve patient care. Interactive Web-based training and focused classroom time for doctors and other medical practitioners can also compliment and re-enforce new IT skills. Leadership has to be an active and vocal part of this. It is a time and an emotional commitment, she says.
Of course, with the many systems and interfaces available for healthcare settings, Metters admits that hospital administration and IT personnel need to be highly aware of the particular needs and work patterns of their staff and doctors before they choose and implement any large-scale tech changes. He notes that physicians will be more likely to use electronic health records, for instance, if they believe the technology isn't cumbersome or too time consuming to use. Metters adds that hospitals are looking to business for workflow strategies, using, for example, Toyota's production system to make their institutions much leaner operations. What we've seen is that some hospitals have simply junked complex IT systems, and they've opted for something that is much more user-friendly.
Cantrell notes that electronic health records and other computerized tools in a clinical setting need to be relatively intuitive. Online dashboards with obvious icons, for example, can provide an easy and quick way to access patient data and show workflow, so patients do not simply get lost in the system. Ready access to such data allows physicians, nurses, and radiologists, for example, to understand where a given patient stands in the hospital queue while awaiting an MRI result. Ultimately, says Cantrell, cost savings are wonderful, but technology implementations in the healthcare setting must be focused on patient care and safety. Automation and collection of clinical info on the patient-anywhere and anytime-is really what it is all about. It's really about enhancing the quality of care.