With the click of a mouse, Dr. Reid Coleman places an antibiotic order from his personal computer for a patient at Rhode Island Hospital. Instantly, a warning message pops up on his screen in bold red letters.
“You are ordering a penicillin-based antibiotic for a patient who is allergic to penicillin,” the message tells Coleman, medical director for Lifespan/Physicians PSO.
It’s only a test, an order that will never get filled for a patient who doesn’t exist.
But by the end of the year, doctors at two undisclosed Lifespan hospitals will begin piloting a new program that will allow them to place all their patient orders – from medications and dietary restrictions to cardiac tests and X-rays – through a secured computer network.
The program eventually will replace the system of chicken-scratch doctors’ charts and illegible prescriptions. Instead, physicians will write orders by clicking on medications, dosage levels and frequencies, all displayed on pre-set lists. Orders will be sent electronically to the hospital pharmacy while a history of the doctor’s selections is stored in the system.
The “physician order-entry system” – in the planning phase for more than a year – is designed for the convenience of both the doctors giving orders and for the nurses, radiology technologists, pharmacists and other hospital personnel carrying them out.
But more importantly, Lifespan officials say, the new system goes right to the heart of one of the most contentious issues facing the health-care industry today: medical errors.
Had Coleman’s penicillin scenario really played out, he says, a potential medical error would have been avoided.
“Mistakes in prescribing medications are the single most common cause of errors in hospitals,” Coleman said. “And (with the new system), I can’t do it. I can’t put the decimal point in the wrong place, I can’t pick the wrong drug, I can’t misspell it and my handwriting doesn’t matter.”
It’s a massive undertaking, part of Lifespan’s six-year, $50 million investment in a new, integrated clinical-information system that eventually will span all its affiliate members, including Rhode Island Hospital, The Miriam Hospital, Newport Hospital and New England Medical Center.
The order-entry component likely will take a few years to fully implement. But the “guts” of Lifespan’s new information system, “LifeLinks,” has been fully employed for a few months.
The Web-based system enables doctors at every Lifespan affiliate – including independent physician offices – to get all their patient information on the same computer interface, whether from their hospital PCs, off-site offices or even on wireless devices such as Palm Pilots.
“These systems, especially the physician order-entry system, will enable us to dramatically reduce medical errors,” said Lifespan CEO George Vecchione.
Vecchione sees the implementation of LifeLinks as a shining example of Lifespan’s core purpose: To bring better health-care to patients at reduced costs.
“Frankly, this is the type of product that you won’t see coming from an individual hospital, principally because of the cost,” Vecchione said. “It requires a significant up-front investment, but over time, from a delivery-of-care perspective, it costs less to provide improved quality of care.”
LifeLinks uses a private, password-protected network that allows physicians to access just about any piece of information on a patient. Is the patient allergic to any medications? Does he or she have any dietary restrictions? If so, all that information is available.
“No more of this ‘Did the patient remember to wear their med. alert? Did they remember to carry their wallet card?'” Coleman said. “We’ve got it, and it can be entered at any point in the system.”
Doctors also can track patient progress after orders are placed. Eventually they’ll be able to place orders through the system via the physician order-entry program, which is a component of the overall LifeLinks system.
“The idea is always the same: Put all of the information that we can right at the doctor’s fingertips at the decision-making point,” said Carole M. Cotter, Lifespan senior vice president and chief information officer.
Coleman points to what he says is a frequent scenario: A patient shows up in the emergency room at Rhode Island Hospital with chest pains and doctors order a cardiogram. The test is normal, but doctors might admit the patient because they’re not sure what’s wrong.
“Then we usually have to wait for somebody to find an old EKG (from another hospital) and mail it to us,” Coleman said, adding that faxes of EKGs are too grainy to read.
“Now, click on a patient’s name and it’s all there,” Coleman said. Up pops a list of the last five test results – in reverse chronological order – from any hospital in the Lifespan network, including data from EKGs, lab tests, X-rays, MRIs and ultrasounds.
The system also reminds physicians of basic but sometimes-forgotten clinical protocols. For instance, if a doctor is writing orders for a heart failure patient, the computer might suggest ordering a statin drug.
There are also links to archived medical journals and other reference information so physicians can review literature on certain medicines or diseases.
And all the information can be downloaded to physician’s wireless devices: Web-enabled cell phones, tablet computers and personal digital assistants such as Palm Pilots.
“Doctors can download rounds reports from clinical information gathered as they walk from patient to patient on the floor,” said David S. Hemendinger, Chief Technology Officer for Enterprise Systems Infrastructure at Lifespan. “This way they can treat patients right at the point of care.”
Despite the health-care industry’s best efforts, human mistakes are inevitable. But Lifespan officials say the new information system is a way to eliminate systemic flaws that pave the way for human errors.
“For every error there’s a sharp end to the problem – a human mistake – but there’s a blunt end, which is the system that permits it to happen,” Coleman said. “We’re plugging the hole in the blunt end.”
The system also is improving nursing processes, officials said. Nurses in a pilot program under way at Newport Hospital are using laptop computers – wirelessly connected to the hospital’s network – at the bedside to input patient vital signs, history and other information. That program will be introduced at Rhode Island Hospital and Miriam in January.
