Anytime a patient enters the healthcare system, she ends up
repeating the same information to countless people: insurance
number, medications, allergies, preexisting conditions.
Why can't a worker in a hospital or doctor's office simply punch
the patient's name into a computer and have all that data pop up,
the way your bank or credit-card company does?
''It's not easy. There is a myriad of different software
information systems in place,'' says Bob Reese, chief information
officer for Memorial Healthcare System in Hollywood. ``There is a
complete lack of standardization.''
The issues here are crucial. Gov. Jeb Bush has established a task
force in Florida to discuss creating standards so that all
healthcare programs can talk to each other, and the group is sending
its first report to the governor later this month.
Experts are not expecting an optimistic assessment of how much
progress has been made. ''Well, it's been slow,'' says Paul Barach,
director of the Center for Patient Safety at the University of
Miami, who did a survey last year of how hospitals were doing in
technology.
The stakes are huge. Computers can move information faster and
cheaper -- a crucial issue considering the industry's constantly
rising costs.
THOUSANDS SAVED
Computerized systems might also save thousands of lives a year by
diminishing errors through such measures as electronic ordering and
tracking of drugs, eliminating doctors' scribbled prescriptions.
In Washington, President Bush has appointed a czar for health
technology to see if the process can be speeded up.
No one is even guessing at how much this will cost healthcare
industry and, ultimately, consumers. In improving safety and
speeding up information, the tech conversion could save money, but
in the long run the costs could be huge.
''It would be rather difficult to come up with a number,'' says
Michael Heekin, head of the Florida task force. But everyone agrees
the health system must convert to all-electronic records. ``We can't
just have islands of information.''
A grim example comes from HCA, the hospital chain, which spent
$100 million trying to convert its financial operations nationwide
to a uniform software platform before abandoning the effort in 2003
because it seemed unworkable.
Still, HCA and many other hospitals are charging ahead.
Experts say that hospital conversions may be easier than getting
doctors involved.
Baptist Health South Florida has been working hard at this. Its
technicians trained 800 doctors one-on-one on how to use its
electronic systems to look up patient information.
Ultimately, Baptist and all hospitals want to go to Computerized
Physician Order Entry, meaning that doctors tell nurses, labs and
others what to do electronically, not with scribbles on paper.
Surveys show that CPOE is far more effective in cutting errors
than drug barcoding, which involves putting identifying strips on
medicine containers, the way supermarket items are marked for
automatic reading by cashiers.
The problem is that doctors tend to be hurried and generally
don't like being told what to do. When a California hospital
installed a CPOE system and simply demanded that doctors start using
it, the physicians rebelled en masse and refused, says Paul Barach,
director of the Center for Patient Safety at the University of
Miami. ``Behavior change is most difficult.''
OVERWORKED DOCTORS
Overworked doctors sometimes don't want to spend even a minute to
log on to a hospital system.
Baptist Health is starting a pilot project in the physicians'
lounges at South Miami and Baptist hospitals to see if doctors can
log on simply by touching a mouse that can detects finger
prints.
Alan Bramblett, a Baptist Health technology manager, says the
hospital system has two tech employees whose only job is to sit in
the lounges and, when they can grab a doctor's attention, show him
how the system can work.
This solves only part of the problem, because much of what
happens to patients is in the doctors' own offices, which may not
link up at all with hospitals.
''There's confusion about all the different software and hardware
choices,'' says Bernd Wollschlaeger, a primary-care doctor in North
Dade. ``They're worried, `If I buy this, what happens if it's
out-dated in two years.'''
Wollschlaeger, who has researched this issue for a physician's
publication, thinks it's best to lease systems through application
service providers, ``so all you need is a basic computer and
high-speed Internet access. You can do this for no more than a
couple of hundred bucks a month.''
The software sits on the providers' servers, and if better
software comes along, the providers must pay for the changes -- or
the doctors can migrate to different systems.
Even with all this, health technology experts know that
ultimately the industry must have specified standards so software
and hardware can talk to each other, and electronic health records
can move seamlessly everywhere.
David Brailer, the federal health tech czar, is organizing
discussions with the industry about finding ways to do this, and it
remains unclear whether the industry can voluntarily set standards
or whether the government must impose them.
''That's the big question,'' says Heekin, head of the Florida
task force.
``I think at the end of the day healthcare is delivered locally,
and it will be a mixture of state and federal initiatives that solve
this. But we don't want to understate the task ahead of us.''
