ZIFFPAGE TITLEMedical Images Abound at

By Deborah Gage  |  Posted 2004-08-01 Print this article Print

CCH"> Among similarly sized U.S. pediatric hospitals, the National Association of Childrens Hospitals has ranked Cincinnati Childrens second in the number of surgical procedures performed (24,000 inpatient and outpatient procedures in fiscal 2003) and fourth in the number of emergency visits (84,486 in fiscal 2003). In all, the hospital last year saw 700,000 kids for traumas, liver ailments, and heart and bone marrow transplants. Dr. Johnson, a slim, 51-year-old radiologist who was born in Australia, glides quickly across the facilitys finely polished floors, offering a friendly "Gday" to the doctors and nurses he recognizes. A typical day for Johnson, who coordinates the hospitals medical services with its information-systems initiatives, might be a morning meeting in his office to explain a plan to install a new medical-imaging management system, and an afternoon over an operating table where hell take a biopsy of a 16-year-old boy with a strange growth in his hip. After a doctor recruited him to the States, Johnson found himself in Cincinnati in the late 1990s just as radiology digital-imaging systems, known as Picture Archiving and Communication Systems (PACS), were coming onto the market. Soon, Johnson was helping get one of the systems installed in Cincinnati Childrens radiology department.

Between 85% and 90% of patients at Cincinnati Childrens have an X-ray, CT scan or other medical image taken. But, Johnson says, when he arrived, the department was awash in pictures and paper files: "It was obvious what had to happen."

The imaging archive Johnson put in place was the hospitals first big deployment of an information system for a clinical service. Today, Cincinnati Childrens uses no film. The system captures X-ray, Magnetic Resonance Imaging and other medical images in digits and then zaps them around the hospital. Images are put up as dots on screens, not sheets of film in folders, speeding analysis and reporting.

Now it takes just 7 hours for a doctor to examine X-rays and CT scans and prepare a report on a patients condition. In 2000, it took more than 28.

In the use of computers, Johnson says, "Radiology was way ahead of the hospital."

But some doctors, such as orthopedic surgeons, resisted. They wanted to hold a picture in their hand, or didnt want to take the time to log in to a computer to see medical images, or both. User complaints are something Johnson has gotten accustomed to over the years, and they are commemorated by decals of bullet holes on his office door. "We got shot at a lot," he says. But the archiving team slowly brought dissenters along.

Johnson personally spent time with the doctors, showing them the ropes, and even took some of them on field trips to other hospitals that had adopted the system to show skeptics how the system helped save hours in figuring out the problems a patient was experiencing.

"It was a standoff for a while," he says. "But I knew it was the right thing to do."

About the time Johnson was completing the PACS system, the Institute of Medicine issued a sobering report asserting that errors in medical treatment killed as many as 98,000 people per year. The report shocked the public, while the medical community debated fiercely whether the institutes death rates were accurate. There was, however, no debate on the central thesis: Everyday errors in prescribing and executing care for patients were a big problem. And just recently, on July 27, a Colorado health-care consulting firm, HealthGrades, released a study that doubled the estimate of deaths each year due to medical errors, to 195,000.

The 1999 Institute of Medicine study and an internal report that found its own staff making medication errors forced Cincinnati Childrens to concentrate on how to protect its patients from human mistakes. By 2000, a committee of doctors, nurses and staff were looking into the benefits of computerized medication order entry. The group found several studies indicating that computer systems for ordering drugs did in fact reduce errors from bad handwriting, could warn physicians about potential overdoses, and tracked procedures and medications better than paper-based systems.

A 1999 study by a group of physicians, including Dr. David Bates of Brigham and Womens Hospital and Harvard Medical School, and Dr. Jonathan Teich of the Harvard School of Public Health, found that medication errors fell more than 80% when a hospital installed an electronic order system, although the paper also warned of the potential for "causing new errors."

The committee recommended that the hospital move to computerized order entry. Hospital managers were also realizing that what the hospital really needed was to automate and integrate all of its patient care processes. The paper-based process that had long been in place, says chief executive officer James Anderson, was "inefficient, shabby."

At that point, however, the hospital managers had little inkling of the challenges ahead.

Next Page: System Operations.

Senior Writer
Based in Silicon Valley, Debbie was a founding member of Ziff Davis Media's Sm@rt Partner, where she developed investigative projects and wrote a column on start-ups. She has covered the high-tech industry since 1994 and has also worked for Minnesota Public Radio, covering state politics. She has written freelance op-ed pieces on public education for the San Jose Mercury News, and has also won several national awards for her work co-producing a documentary. She has a B.A. from Minnesota State University.


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