New health care IT options only the tip of the iceberg
HIMSS conference highlights high-tech solutions.
The "tip-of-the-iceberg" cliché got quite a workout at the recent 2002 annual Healthcare Information and Management Systems Society (HIMSS) Conference and Exhibition held at the Georgia World Congress Center in Atlanta on Jan. 27-31.
In his presentation, "Using Information Systems to Screen for Adverse Events," speaker R. Scott Evans, MD, used the iceberg-tip example to detail his experiences implementing computer information systems for the LDS Hospital and Intermountain Health Care organization in Salt Lake City.
"A wealth of information is already there," Evans said, pointing to a slide of the proverbial mostly submerged big block of frozen water. "[With] all events reported, you’re going to get the tip — 99% of it is down here, and we just had the little tip up here."
While computer systems monitor a number of patient outcomes, such as clinical events and infectious diseases, adverse event monitoring has experienced a significant boost largely due to an improved process and advanced technology. The need further has been heightened by the Institute of Medicine report pointing to thousands of deaths each year in the U.S. as the result of medication errors. That report continues to be the bellwether document pushing better tracking of such events.
"The only way we found out about adverse drug events was [through] the nurse," Evans said. "The nurses had to fill out the incident report, they had to determine or put down what happened, what the clinical manifestations were, what they did to treat the problem — and fill all of that out on a regular sheet piece of paper. And then you had to have the attending sign it and the nursing supervisor. So after all that time and hassle, we only had nine or 10 adverse drug events [reported]."
Pharmacists quickly experienced the benefits of the new computer tracking system.
"It became very apparent to pharmacists that about 50% of the time, doctors were not [seeing] appropriate clinical manifestations of an ADE or a drug," Evans said. "Quite often they thought it’s another underlying problem. So what would they do? They would order another drug."
At another presentation, called "Improved Medication Management," Dennis Regan, MD, expounded on the benefits of streamlined interfaces between physicians and pharmacies. As the medical director of information services, Regan has spent the last couple of years establishing such a system at the Deaconess Billings Clinic in Billings, MT, which serves a patient population stretching from Montana into the Dakotas and Wyoming.
His first task was correlating various sources of reference.
"We had hospital information systems you could hook upon, and we had transcription," he said. "We had hospital notes, hospital discharge, clinic notes. So looking back at the repository, you can really see what happened."
The challenge of changing habits
Implementing software to handle the information was not a major difficulty, Regan said, but changing practices and habits was more of a challenge.
"The problem was this was a huge change in the way people do their medication [transcription]," he said.
But the new system drastically reduced the prescription refill process, which Regan said often took in excess of six hours. It didn’t take long for doctors and nurses to change their habits.
"Basically, we had 100% adoption by the time six months rolled around, meaning that nursing staff was doing it essentially 100% of the time," he said. "If you recall, it took six hours and 32 minutes [for the manual refill process] — it took the computer refill request down to one minute, 34 seconds. Instead of 3.2 calls per request, we were down to 1.4."
Obvious improvements to immediate patient care notwithstanding, the more accurate computer systems resulted in a number of other benefits. Emergency rooms, for example, often operate without access to patient charts if one is admitted after clinics or offices are closed for the day. Computer network access allows emergency doctors access to a patient’s history, ultimately saving them time from the beginning.
Evans also pointed to fewer incidences of unnecessary antibiotic prescriptions. In Regan’s examples, overtime for nurses dealing with prescription refill requests was markedly reduced. Improved legibility and computer decision support also point to improvements.
All the data seem to indicate the benefits of streamlining such processes.
"The people we’ve done this with make it worthwhile," Regan said.
After all, it appears the end result is helping the health care industry get beyond the tip of the iceberg.
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