ZIFFPAGE TITLESystem Operations

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

System Operations Today, the hospital has ICIS in place. The system is based on a software bundle from Siemens Medical called Invision that helps Cincinnati Childrens and scores of other health-care providers with everything from record-keeping to billing to order entry to tracking patients medications. In the mid-1990s, the hospital was using Invision for billing and other financial functions. But it wasnt until 2000 that it tried to computerize the way doctors entered orders for medication and other clinical treatment of young patients, and to keep a digital record of vital signs, weights and assessments of a patients condition.
That didnt mean the Siemens system could do all that. The Siemens software, for instance, couldnt check the accuracy of doses of medicine prescribed for young patients, couldnt fully process critical-care nursing documents, and didnt easily integrate with other systems the hospital decided to use. In addition, the hospitals information-technology staff had to come up with a way within the system to, for instance, capture and program the order sets that would standardize repeatable medical treatments.
The icis software, and the hardware needed to run it, cost about $14 million—no small amount for a hospital with an annual budget of about $20 million for information technology. The hospital would also find that its new software would overload its mainframe system, necessitating the $1.8 million purchase of new computer and storage equipment. "We ran into our share of implementation issues," Johnson says. There were people challenges as well. Doctors, long accustomed to simply telling nurses how they wanted patients cared for and scratching a few lines on a prescription pad to order medication, now would be required to fill out specific fields on screen to say how a patients care should proceed. Even a simple request for aspirin would have to be typed in before it could be sent to an on-site pharmacy. The time taken to order treatment can be as time-consuming as the treatment itself. Ear, nose and throat specialists, for instance, can often perform a simple ear-tube insertion procedure, which helps kids drain fluids from their ears, in about 5 minutes. In the past, when they were done, they could just tell a nurse how they wanted their patients to be looked after. The system requires these doctors to sit at a computer terminal, log in, fill out an order—say, for an antibiotic—and log back out. That could take 5 minutes each time. With 20 or more procedures a day, that can add hours to their schedules. To overcome this problem, Johnson says the team honed the ENT order set. Since ENT doctors rarely deviate from common after-care orders, they werent presented with multiple choices on which drugs to order or the amount of time the child should be watched by a nurse before discharge. The system instead presents a complete screen the physician can simply OK with a few clicks. Additional choices are presented only if the care deviates from standard procedure. Other problems werent as easy to solve. One of the biggest hurdles was adding a dosage-checker for kids and newborns such as Baby J. Many systems for adults, including one from Siemens, come with a program that checks medications against a list of characteristics and requirements, such as how the drugs interact with other pharmaceuticals and a patients maximum allowable daily dose. When there are potential problems, such software may flash a red "Dose Check Warning" message on the screen when a single order exceeds the recommended daily dose.
But few if any vendors on the market offer a product to check for errors in pediatric prescriptions. Part of the problem is that dosing children is a major challenge, says Marianne James, the hospitals vice president of information services.

"In an adult hospital, you dose based on a vial of this or a capsule of that," says Dr. Brian Jacobs, the hospitals director of technology and patient safety. "We take care of children who range in size from 500 grams [about 1.1 pounds] all the way to 150 kilograms [about 330 pounds]. In children, we always dose per kilo. So a dose of morphine is 0.1 milligrams per kilo. Thats a very different dose for a premature infant than it is for an obese adolescent."

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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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