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April - 2005 - issue > Technology
Strategic all the way
Ashwini Kachapeswaran
Friday, April 1, 2005
Right Patient, Right Drug, Right Dosage, Right Route and the Right Time are factors that hospitals around the country strive to achieve without technology. The health care industry has made headway in patient care and treatment options while often lagging behind using the benefits of information technology. Late reports, lost samples and ID Errors are a few bugs and costs dearer to every hospital in the country. Yet, many hospitals do not invest in technology to overcome these bugs.

With the health sector going digital, it is not surprising to witness a nurse pull out a tablet PC, log into the hospital system and receive details for drug administration. Its quite a jolt when a doctor enters a prescription and gets a warning message that it might contradict with the drug the patient is already taking. According to a recent report by BusinessWeek, doctors can now log into their hospital systems from their homes into a life-size robot to do their rounds and prescribe drugs! Nurses and doctors could also use the television set perched in a patient’s room to access medical records with a flick of the remote!

Welcome to the world of Health Care Information Technology. The digital age has finally dawned; hospitals are seeking to revolutionize their networks with state-of-the art technology and high-end customization that meets every need.

The Dorenfest research group estimated that HIT would grow by 9.3 percent, rising to $30 billion next year from $25.8 billion in 2004. Rising medical costs, worker shortage, and Federal mandates has steered the focus of the health care industry toward improving quality and patient safety. The number of hospitals in the U.S. has dwindled to 5,200 from 12,000 in the last ten years. In Pennsylvania, the aging population is only second to Florida with 16 percent of people over the 60 years of age.

These facts have forced hospitals such as the Reading Hospital to concentrate on their patients and their safety. Steering the Pennsylvania-based hospital into the world of IT is its Vice-President and Chief Information Officer, Jayashree Raman.

Raman focuses on providing technology that enables quality healthcare, emphasizing patient safety. In the past year, she has successfully implemented two projects enabling care providers to concentrate on patients, not on paper work. Raman implemented the Medication Administration System, Picture Archiving and Communication System, and is in the process of implementing the Physician Order Management System at The Reading Hospital for inpatients and in outpatient electronic medical records (EMR).”


“At hospitals we require new approaches to manage care delivery. At The Reading Hospital our IT plan is tied very closely to our strategic plan and our strategic objectives is to improve quality, reduce cost and improve patient safety,” Raman says.

“Our initiative was to meet these goals, and last year we undertook the program for Medication Administration Record System. Under the MAR we focused on the five rights— Right Patients, Right Drug, Right Dosage, Right Route and the Right Time.”

The five rights synchronize with the MAR system and even if one of the five rights is off track the system will alert the care administrator. “The nurse wheels in a mobile cart were the medication is bar-coded, the nurse has a bar-coded ID badge, and every patient is bar-coded. If all three are not in sync, the system on the cart gives an alert,” she says.

The Reading Hospital aggressively implemented and completed the process in approximately 10 months. With the national statistic increasing to almost 90,000 deaths reported due to wrong drug event at hospitals, this is a strategic move for the hospital. Emphasizing patient safety, Raman says, “After we put the MAR system in all our in-patient areas, we saw a dramatic decrease in patient identification errors.”

“We have so many checks and balances before drug administration we were able to address significant patient safety issues.” The Reading Hospital is now automated. “The pharmacy system is completely automated, and the MAR is in sync with the pharmacy system, enabling safer drug administration,” she adds.

Furthermore, the hospital is now advancing their technical capability. Raman says, “We are now Beta testing a product where your TV device also becomes the clinical device. When a nurse comes in, she will be able to switch into the medical system and administer the drug without having to use a mobile cart.”

Raman is now working on implementing the Computerized Physician Order Entry system. “We are in generation three of their iteration, and we will do our pilot test in August, 2005,” she says. Generation three systems assist in clinical automation, help gather data, and aids physicians to make clinical decisions.

The CPOE systems are bought from different vendors and customized according to the hospital’s needs. “CPOE addresses a lot of issues. One main advantage is avoiding illegible hand-writing, which removes interpretation by the drug administrator, thereby promoting patient safety,” Raman points out.

As automation slowly takes over, studies show there are better outcomes with evidence-based medicine. The CPOE gathers data and can assist the physician in making better clinical decisions. “If a patient has a conflicting blood result, the system could alert the doctor with suggestions.”

“If a patient has a conflicting blood result, the system would alert the doctor with suggestions,” she adds. This provides a protocol-driven practice in administering medication to treat patients. “When everybody is following the protocol, patient safety is taken care of.”

“We provide access online to labs, radiology images and reports, orders, histories and physicals, operative notes, and discharge summaries,” she says. She implemented the Picture Archiving and Communication System last year. “In the radiology department, all our digital modalities are on the PACS system like X-Rays, MR, CT, and Ultra-sound. Radiologists are now able to view images online and read them. This has a tremendous impact on our productivity,” she says. 92.9 percent of inpatient radiological studies are read within six hours. The major contributing factor has been the digitizing of images which results in better patient care.

The in-house study done by the hospital concludes the chances for a radiologist to read the X-Ray within six hours rose from 58 percent to 86 percent.

With the market overflowing with fashionable gadgets, care providers have a variety of options to choose their hardware. In the U.S., use of Personal Digital Assistants (PDA) by medical staff increased by 47 percent between 2001 and 2002 and has steadily grown. The Taking the Pulse study published in October 2004, by Manhattan Research found that 40 percent of all U.S. physicians use a PDA, compared with 35 percent in 2003.

It not surprising to see a doctor when paged, step into the elevator, pop out a tablet PC and log into the hospital medical system to see a patient’s report before reaching the patient! But this optimistic scenario may not be true, as hardware selection and adoption is one of the key issues the Reading Hospital is working to untangle.

“Hardware selection is a key part of this venture. One kind of hardware will not fit every physician’s needs. We have a core team comprising multi-disciplines from physicians, nurses, pharmacists and IT all working together to helping us decide on the hardware,” she says. “The Reading Hospital is totally wireless. This gives physicians a variety of options to choose from, be it a wireless device, tablet PC or a desktop,” Raman says.

Often, hardware or technology adoption is met with skepticism. Doctors and nurses unwilling to adapt to new technology express discomfort and impatience with such change.

“Several physicians participate in our IT initiative because of their interest,” she says. “Hospitals do face such resistance, unless and until federal mandates are implemented it is going to be a tough route for hospitals to take,” she expressed. The focal point is such initiatives have long-term effects on hospitals and short-term measurement may not be ideal for hospitals.

“More than saving time in the short-term, such systems over time enable efficiency for physicians, but initially it is going to be challenging,” she remarks.

Besides federal mandates, private organizations have reward and incentive programs for technology adoption. The Leapfrog Group, represented by industries that buy health care, is working together to promote patient safety. The group provides incentives and rewards to hospitals for implementing safety standards such as MAR and CPOE. The group is represented by 160 organizations that provide health care and these providers encourage patients to visit only hospitals that have implemented Leapfrog’s safety practices. The three safe steps, or “leaps”, include the CPOE, Evidence Based Hospital Referral and ICU physician staffing. The Reading Hospital has already taken their proverbial leap into the world of automation, improving health care quality and patient safety.

In 2004, the Institute for Safe Medication Practices (ISMP) gave the Reading Hospital the National Patient Safety Award for implementing the RxToolkit used by pharmacists. The hospital’s pharmacy is completely automated and provides greater safety in administering drugs to this 566-bed West Reading facility, spread across the a 36-acre campus.
With 80 people in her IT team, Raman is working progressively to adapt technology and initiate new trends into the day-to-day workings of the hospital with the sole aim of providing excellent quality and patient safety.

Raman says, “Healthcare Information Technology is definitely gaining popularity. The paradigm is shifting in terms of technology and with federal involvement bringing about such change, the only question is how soon this will happen.”

“The Healthcare Information Technology needs more grants and initiative from the government for hospitals to afford such technology,” she says.

A practical CIO with a strategic and tactical approach, Raman has a vision of a patient-centric digital clinic repository for all text-based information, involving all modalities, which can be accessed electronically anywhere. The IT direction is one where both patient and caregiver are served well to optimize patient care.


“I hope I see that happen before I retire,” she says.

Will the new IT trend in healthcare introduce a digital wave? Many issues such as federal mandates, technology adoptions, high implementation and maintenance costs is widely debated to play a key role in the future of healthcare in information technology. But with the experience of the Reading Hospital, the future seems brighter and safer.

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