Digital Medicine | Bar Code Systems Reduce Risks in Local Hospitals
In late November, when actor Dennis Quaid’s infant twins received a hospital-administered overdose of blood thinner, the fact that many of the nation’s hospitals had not converted its paper files to digital systems came as a surprise to many. While Quaid’s twins slowly recovered, that good news couldn’t hide the glaring clerical flub that caused the toxic overdose.
It also couldn’t hide the fact that when it comes to adopting electronic office procedures — generally the accepted standard in every other business — doctors and hospitals are often notoriously stubborn.
In some cases, such loyalty to paper files and scrawled notes is responsible for gross human error that leads to tragic results.
However, what’s been slow to catch on in hospitals nationwide is now becoming standard in Greater Hartford.
Saint Francis Forerunner
In fact, Saint Francis Hospital spearheaded local efforts nearly two decades ago when it implemented its computerized physician order entry system (CPOE). The system allows physicians to enter their medical orders electronically and have that order linked to other departments in the hospital, like the pharmacy, to begin processing.
For other area hospitals, the paperless conversion has been slower. Cost is certainly a major factor, but hospital reticence is largely because of how complex clinical situations are, said Stephan O’Neill, vice president of information services at Hartford Hospital.
“There are just so many different factors involved in patient care,” he said.
Plus, doctors are trained in the classic, paper-file methods, he said, and it can be tough to evolve the status quo.
Hartford Hospital finally closed the technological gap with Saint Francis four years ago when it began implementing its own physician order entry system. Its program has now been up and running for about a year.
And earlier this month, John Dempsey Hospital officially joined its Hartford-area counterparts, completing a year-and-a-half-long process of automation from physician order to medication administration.
“It’s ensuring the level of care that we give,” said Roberta Luby, associate vice president of IT strategic projects at the University of Connecticut Health Center.
John Dempsey’s order-entry system provides online clinical physician support: incorporating best practice guidelines as well as a full alert system for drug allergies and potentially harmful drug-on-drug interactions. Currently, the system is available in all the hospital’s acute care units, and the rollout will continue until the system is available hospital-wide.
From Paper To Barcodes
Joining the CPOE system is the hospital’s new medication administration checking system (MAK), which ensures that the right person gets the right dose of the right medicine at the right time and through the right route (oral, topical, etc.).
The system would likely prevent a Dennis Quaid-like situation by eliminating the potential for human error. The nurse scans the bar codes attached to the medications and the patient’s wrist band. The computer system signals if the medication, doses and patients match, providing a final checkpoint and approval.
Hartford Hospital also adopted a medication monitoring system, now in place for about a year. That, coupled with its CPOE system, has earned Hartford Hospital a spot on the list of the nation’s “Most Wired” hospitals. That’s according to the 2007 Most Wired Survey and Benchmarking Study released in the July issue of Hospitals & Health Networks magazine.
But the conversion from paper to digital technology is expensive. Technological upgrades have set Hartford Hospital back about $30 to $40 million over the past few years, but O’Neill said it is well worth the investment.
“We feel it’s somewhat of a mandate because it’s time to take advantage of these systems,” he said.
Cost Benefits
Saint Francis Hospital also implemented a medication monitoring system in about 95 percent of patient care units to complement the checks and balances available through its CPOE system. What the CPOE’s clinical alerts don’t catch, this back-end monitoring system will.
“It’s been a big capital investment,” said Maria Summa, director of pharmacy at Saint Francis. But it’s earned the pharmacy department the Connecticut Quality Innovation Award, which was presented to the team in June 2007.
There are cost benefits to these systems that will help alleviate the initial price of implementation, mostly in terms of efficiency. Computerization is the assembly line of the hospital world and could help hospitals see more patients in the same amount of time while still maintaining quality of care.
Plus, with more checks and balances in place, hospitals decrease their risk of mistakes and subsequent malpractice lawsuits.
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