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Consider this: each year, more people in the United States die from medical errors in hospitals than from highway accidents, breast cancer or AIDS. This statistic, issued in 1999 by a private Washington-based research organization, the Institute of Medicine, startled health care providers throughout the country. But officials at CareGroup Healthcare System, a network of six hospitals in the Boston area, didnt just shake their heads in dismay. They decided last year to tackle the problem by spending just under $3 million to develop Web-based applications to improve patient care.
Their first target was an outdated and error-prone process used by physicians to order prescriptions. As at most U.S. hospitals, doctors wrote prescriptions by hand and faxed or delivered copies of them to pharmacists. CareGroup replaced that with a Web-based system that not only allows doctors to place prescription orders online but also connects to electronic patient medical records. That way, it can alert physicians to possible drug interactions or past allergies, said Dr. John Halamka, CIO at CareGroup. It also reduces errors caused by hard-to-read handwritten prescriptions.
“Doctors spend 20 years learning how to hand-write badly,” Halamka said. “You can imagine that the difference between 0.5 mg and 5 mg can kill you.”
So far, the online prescription ordering system, which cost $2.5 million to build, has cut out 90 percent of medication errors on one floor of Beth Israel Deaconess Medical Center, in Boston, CareGroups largest hospital, where it went live in June.
But CareGroup didnt stop there. Early this year, its IT department began working on streamlining the process used for tracking patient status in emergency rooms. At Beth Israel, they replaced a physical whiteboard with a 5-foot-wide electronic one displayed within the emergency room and accessible by doctors through the Web and over a 802.11b WLAN (wireless LAN). The so-called electronic dashboard, which cost $250,000 to develop, has not only received praise from the 50 doctors and nurses on the floor during each shift, but it has reduced the average patients time in the emergency room by a half-hour by giving doctors and staff up-to-the-minute information on things such as patient lab tests, Halamka said.
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Playing Catch-Up
CareGroup is rare among U.S.-based health care groups in using the Web to improve processes such as prescription ordering and ER care. The United States, in fact, lags other English-speaking countries in the use of electronic patient records within its health care system. Only 17 percent of U.S. primary care physicians use electronic medical records compared with 59 percent of primary care doctors in the United Kingdom, according to a survey conducted by Harris Interactive Inc., of Rochester, N.Y.
Part of the reason for slow adoption of Web technologies at U.S. hospitals is their concentration on complying with the security and privacy regulations of the Health Insurance Portability and Accountability Act, said Lauri Ingram, an analyst at Meta Group Inc., in Trumbull, Conn. Within five years, though, she said she expects widespread adoption of Web applications to access clinical information as hospitals move beyond HIPAA compliance and as more off-the-shelf applications become available.
Faced with a dearth of packaged Web-based applications for hospital functions, such as prescription ordering, CareGroups Halamka chose in-house development. His team created systems in Active Server Pages and Visual Basic Script running on Microsoft Corp.s Internet Information Services 5.0. Both systems access 21 terabytes of patient records and financial data. The patient records are stored on the Caché database from InterSystems Corp., of Cambridge, Mass., running on a Unix server. Financial records are on a Microsoft SQL Server 2000 database server.
As with the prescription systems, doctors and nurses can access the electronic dashboard through the Web on a PC or through their own handheld devices. The dashboard not only provides a snapshot of whos in the ER, but it provides immediate updates when lab results and X-rays are available or when a bed becomes available, Halamka said. Compare this to the old process, where ER staff would physically have to update a whiteboard every hour or so causing backlogs and confusion.
With both systems, security was a concern. So CareGroup uses 128-bit encryption in transferring data and audits all access of patient records. On top of those measures, doctors and nurses with access to the system are provided a log-in and a dynamic password, which is generated every 60 seconds by RSA Security Inc.s SecurID authenticators.
With a favorable prognosis for both systems early use, Halamka is planning to deploy them throughout CareGroup. He will begin deploying the online prescription ordering system for other group hospitals in January. All six will have it within a year. Other hospital ERs should begin using the electronic dashboard later next year.
As the Web becomes more pervasive at CareGroup hospitals, Halamka is confident that the next time he and other doctors there read medical- error statistics, theyll know they are at least bucking the trend.
