28 Jun Using clinical IT to improve care
In the field of medicine, nothing is more important to a physician than the safety and well-being of their patients. Doctors and nurses alike are duty-bound to make sure that every patient receives appropriate treatment with as few errors as possible, pushing through layers of bureaucracy and paperwork to keep even the slightest error from costing lives.
Keeping all this information in one place is an enormous job, and one which, according to Barry Chaiken MD, and James Prekop, is what information technology is ideally suited to. Both men have worked for over two decades in the medical business field, as Chaiken is currently chief medical officer of the American Board of Quality Assurance Utilization Review Physicians (ABQAURP) and Prekop is president of the image management firm TeraMEDICA. At the Digital Healthcare Conference held on Wednesday at Madison, each shared their personal and business experience with attendees in support of IT to help patient care.
“He [Prekop] has built a successful business in Milwaukee, by paying attention to what this conference is all about,” said David Hanson of Michael Best and Frederich in his introduction speech. “I’m also struck by Dr. Chaiken’s ability to cross traditional lines, and blend economics with patient care.”
Chaiken began the presentation by exhibiting data from physician and public surveys on patient safety, pointing out that the goals and desires of those queried were highly consistent despite the placing of responsibility being “all over the board”. 97% of interviewees supported a patient safety initiative, and 99% felt that technology was a tool that could enhance safety and enhance goals such as reporting systems and web access information. Problems with coding medication were also at the forefront, and Chaiken showed that when Computer Physician Order Entry (CPOE) was utilized, safety improvements quadrupled.
“What these show is that safety is at the front,” Chaiken said. “We use technology all the time to make things safer…but technology can also help us with care, clinical tests, and guidelines.”
To create a new process, Chaiken highlighted the fact that for a process to be reliable it needs to be simple, otherwise there is too much confusion. Currently there is a ratio of one-third of all medical orders and files that have an error somewhere down the line, a ratio he calls high…due to its complexity. “It is a miracle that there are so few medication errors considering the number of mistakes that occur,” Chaiken said.
The key step to take to ensure beneficial and widespread adoption of CPOE is to first focus on providing basic clinical decision support to all caregivers. This encompasses offering relevant, up-to-date patient information on a variety of platforms (e.g., desktop, laptop, PDA) across all settings (e.g., hospital, clinic, physician’s home). Using CPOE eliminates confusion over handwriting and allows checking with medication and other clinical databases, while keeping communication channels among caregivers open and clear. It also streamlines the sharing of clinical information on patients by supporting the use of electronic medical records, eliminating the paper chart.
“IT and clinicians have to come together, to build these bridges and figure out what works,” said Chaiken. “It’s one of those wild animals…you’re not going to get this unless you put all data in one place.”
Pekop then took the podium to detail a case study on the framework behind the clinical IT, going with a personal example: his own father. Suffering from an unknown lung condition and frequently subjected to antibiotic treatment, his father was in and out of various clinics and departments which had no connection, meaning that Pekop literally had to carry the medical records in the backseat of his car. By the end of the process when a successful treatment was found, his father’s medical history had been taken five times and amassed a bill of $63,000, as well as an enormous buildup of frustration about wasted time.
Seeing the problems, Pekop chose to approach the problem with a ‘can-do’ attitude, seeing that an infrastructure needed to be established to cut down on the procedural deadlocks. The infrastructure, by his estimate, needs to rely on both physical and logical building blocks, so it is maintained with proper tools and carries any information at anytime. A system that can do this would reduce risk and delays to the patient’s care, while at the same time improving satisfaction on all levels – patient, family, and physician.
“Every physician that touched my father had the best intent, so this is not about people – this is about processes,” Pekop said of the treatments. “It took active interaction to speed things up…I’ve seen the benefits of breaking through these barriers.”
Pekop closed the presentation by showing a slide of “Today’s Tomorrow”, the goals of TeraMEDICA in creating a system to house all medical data. Known as Enterprise Image Management (EIM), the charts depicted a web of all departments linked into a system of EMR and image viewers. Through clinical desktops supplied to each medical professional, there would be the ability to access all information at once.
“Never go into anything without a potential solution, so here’s my potential solution,” Pekop said. “We would much rather have you looking at the world like this.”
Les Chappell is a staff writer for the Wisconsin Technology Network and can be reached at firstname.lastname@example.org.