For most of his career, Dr. Mitchell Levy has ordered tests, treatments and medications for his patients the old-fashioned way: by talking to interns as they walked from patient to patient, or scribbling down notes to be passed on to nurses.
The morning rounds in Rhode Island Hospital’s medical intensive-care unit, where Levy is director, can take several hours each day, so it wasn’t uncommon, in that paper-and-dictation world, for an order Levy gave at 8 a.m. not to be executed until noon.
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And while overwhelmingly, the system worked, the opportunities for error were multiple: if an intern misheard Levy; if the unit secretary misread the handwriting; if a “7” was taken for a “1.” With drugs, especially, the potential mistakes could be very dangerous.
Three years ago, ICU doctors began using computers to enter their orders and keep track of patients’ treatment.
The unit went fully paperless in August 2003, Levy said, one of the few ICUs nationwide that are entirely computerized.
Levy’s unit was one of the trailblazers in a major initiative by the Lifespan network to use the power of technology to improve patient care and safety. The Miriam Hospital’s ICU and Newport Hospital’s rehabilitation unit were also early adopters, followed by other critical-care units at Rhode Island and then, last year, Hasbro Children’s Hospital and the remaining inpatient units at Miriam and Newport. Only Bradley Hospital is not using the system, though doctors there can tap into it.
The effort, which Levy said has brought “enormous” benefits to patients, has involved massive investments: thousands of new computers, hundreds of wireless units on carts for nurses, wireless tablets, personal digital assistants, and most important, a powerful secure network serving not just Lifespan’s hospitals, but also its labs and other facilities.
Doctors can tap in from home or from their private offices – anywhere, anytime. And because the system covers all the facilities together, a doctor treating a heart-attack patient at Newport Hospital can log in and find the EKG the man got at Miriam a month before, and the discharge report from his stay at Rhode Island the previous year.
All Lifespan lab results are online going back to 2000, and can be graphed over time. Even X-rays are in the database, with a zoom-in feature to see the details, and a way to make side-by-side comparisons.
“For some hospitals, we backloaded data, so for many patients we have data that goes back 10 years,” said Nancy Barrett, Lifespan’s director of systems integration and development.
For doctors, having quick access to such a wealth of information is “tremendous,” Levy said. Before, if a patient entered the ICU, someone would have to call the medical records office to have the file pulled out and brought over – no easy task at 3 a.m., especially, Levy said. “It was a source of pretty constant frustration.”
Similarly, if a doctor took over a patient who’d already been hospitalized for two weeks, the paper chart could be huge, making it hard to find critical information about the person’s treatment to date. Now, Levy said, it’s much easier to get the essentials.
“All of these things are small details,” he said, “but saving people’s lives is a matter of small details.”
The system for ordering medications is particularly powerful: It automatically checks for known adverse interactions, allergens, and when relevant, contraindications – say, if a drug isn’t supposed to be given to pregnant women. Doctors can follow links to read up on each drug and the specific problems flagged by the system. And the database is constantly updated: “When Vioxx was pulled, Nancy’s people had it out within hours,” said Reid Coleman, Lifespan’s medical director for information services and a veteran doctor at Miriam.
At this point, about 1,800 to 2,000 doctors are using the system each month to enter their orders, said Carole M. Cotter, chief information officer for Lifespan. In addition, “virtually every nurse” is using the system to look up patient information.
The computerization is still a work in progress, however, and each hospital – each unit – is at a different stage.
Newport, for example, has computerized its emergency department, whereas Miriam and Rhode Island are still doing paper orders in theirs (that will change later this year). But overall, Miriam and Rhode Island are using the system more heavily, for more than 90 percent of orders, compared with just under 80 percent at Newport.
Yet already, Lifespan has made big enough strides to gain national recognition. In 2002 alone, it was named one of the nation’s “Most Wired” hospitals and health networks by the journal of the American Hospital Association, and won a CIO-100 award for enterprise integration technology – along with companies such as CISCO, Dell and Dow Chemical.
Still, don’t expect paper to entirely vanish from the hospitals.
“We, like most hospitals in the country, are in a transition,” Cotter said. “We’re running two parallel systems.
The official patient record is still the paper chart.”
Coleman, who navigates the computer system as easily as any doctor, said he still checks paper charts. “I haven’t heard of a paperless hospital yet,” he said. “It’s something we’re all working toward, but we’re not there yet.”
At the Rhode Island ICU, Levy said the new technology is key to improving care and dealing with the sophistication and complexity of modern medicine. While there’s “no question” that it’s better, he said, it’s definitely not faster, especially at first.
“There’s nothing faster, honestly, than turning to a nurse and saying: ‘Give them XYZ drug,’” Levy said. “I’m very careful not to lie to physicians. It’s going to take them longer. But like all other things
we learn, it gets better and faster with time.”
