Going High Tech At Hands-On Hospitals
Bring up health care these days and you’ll likely be assaulted with a range of reactions. There’s no question that the fate of the industry that safeguards our health and well-being has become the issue as the country marches toward the second decade of the 21st century.
With that in mind, Massachusetts has mandated that all hospitals and community health centers in the state adopt computerized physician order entry by 2012, and electronic medical records by 2015.
A $19.5 billion initiative through the U.S. Department of Health and Human Services is further incentivizing this by offering compensation to health care providers that demonstrate “meaningful use” (an as-yet undefined term) of electronic medical records.
Largely, area hospitals are complying – many are even several years into the process.
But for smaller institutions, as reimbursements continue to dwindle while costs concurrently ratchet up, it’s been a challenging evolution.
Resource Poor
In the end, it all comes down to people, money and time. And for community hospitals, none of those are particularly abundant.
“For many smaller institutions, the resource issue is going to be big,” said Dan Moen, president and CEO of the 153-bed Heywood Hospital in Gardner, calling costs “enormous” and hours required to implement the systems “significant.”
“Some institutions may not have the resources to move forward,” he said.
Up until now, computerized physician order entry — abbreviated as CPOE — has been the norm at larger, more urban institutions, explained Dr. William Muller, vice president of medical affairs at Milford Regional Medical Center, which has 121 beds. Nationwide, only about 10 percent of medical practices have such systems, he explained.
The completely paperless process allows doctors to directly and electronically place orders for a patient’s tests or medications. Built-in logic components also identify allergy interactions and dosage recommendations and lump together items typical to certain conditions so doctors don’t have to individually place orders for each one.
“It’s in place of them scribbling an order and having someone else figure it out,” Muller explained.
Meanwhile, with electronic medical records, all aspects of the process are digital, including progress notes, charts, physicians orders and visit and medication histories.
With medical institutions notorious for their abundance of paperwork, the goal with both processes is to improve efficiencies with labor and record-keeping, reduce mistakes and service duplication, and create instant gratification for doctors when it comes to patient records.
Health, But Not Wealth
But, officials say, they’re not expecting a tremendous boon to the bottom line.
“Implementing these systems will not save any money,” said Steve Roach, CEO of Nashoba Valley Medical Center, with 57 beds. However, “It will improve overall safety and care.”
Nashoba started implementing a CPOE system in early 2008; Roach said the goal is to have it online by June 2011. Once it’s fully functional, doctors will make use of hand-held and tablet-sized electronic devices at the bedside, he said.
All told, the hospital is about 75 percent automated with its record-keeping.
Initial system costs were about $1 million, Roach said, and upkeep is expected to total about $400,000 a year.
Considering the high price tags, some area hospitals might look to affiliate to minimize the financial hit.
Athol Memorial Hospital, for instance, has been exploring an alliance with Tennessee-based Vanguard Health Systems Inc. Discussions are very preliminary, according to Athol Memorial’s community relations manager Marcia Maglione Flynn, but if an agreement is reached, “it will change how we approach everything,” she said.
In the meantime, the hospital has slowly been going digital for five years, most recently introducing “work stations on wheels,” or electronic units that intensive care and medical/surgical unit staff can slide up to bedsides and update without the need for a paper or pen.
“Just because we’re a smaller hospital doesn’t mean we need to comply in a smaller way,” said Flynn. “We just have to be much more efficient. Since we’re small, a lot of us wear many hats. This is just another hat.”
Roach noted a similar hurdle. “We don’t have 100 IT people,” he explained, “We have three.”
Tree-Free
Over the past few years, Heywood has put about $1 million a year into information technology or conversions such as software, hardware, or network building, Moen explained. Now, the facility uses about 80 percent digital processes, and officials hope it will be fully electronic — along with its affiliated Heywood Medical Group — within two years.
One of the biggest challenges: Connectedness between institutions and medical offices, or what’s known as “interoperability.”
“If we have systems that don’t talk to each other, or information that’s not accessible, we defeat the whole purpose,” said Moen.
Therefore, area hospitals are working to incorporate components that will allow them to send and receive orders and import and export records from outside institutions and providers. Facilities are also looking at ways for physicians to access records remotely.
Medical facilities have to be sure to remain “high-touch,” with doctors and nurses still attending the same care to patients.
“If we lose that,” Roach said, “We become more of a factory.”
Taryn Plumb is a freelance writer based in Worcester.
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