Imagine: During your post-operative recovery, your surgeon looks at his hand-held computer and speaks, ordering a set of X-rays and operation reports. Within moments, they’re digitally delivered to your family physician and physical therapist for the next phase of your recuperation. Later, a nurse shows you the results of the surgery on a clipboard-sized tablet – actually a powerful transceiver that downloads data and digital X-rays from the hospital’s wireless network. It’s replete with care instructions for your family during the days following your post-op encounter. The tablet functions both as an audio-video device and a point-and-click computer.

No, it’s not the medical bay in an episode of Star Trek. It’s a snapshot of the future of medical treatment in Kentucky and around the nation. And depending on where you live, it may be a scenario you’ve already experienced.

Increasingly, hospitals around the state are investing in a high-tech, instant-access milieu that marries innovations like infrared systems that track patients and nurses with digital medical records that cut paperwork, manpower and overall costs.

From Louisville’s pace-setting Jewish Hospital, to the Ephraim McDowell Regional Medical Center in Danville, to Our Lady of Bellefonte Hospital (OLBH) in Ashland – in fact, in virtually every part of the state – health care administrators are experimenting with new ideas that place Kentucky in the vanguard of health care in the United States.

Of course, there’s nothing new about paperless health care, which hospitals around the county advertise and President George Bush has challenged the industry to implement as a standard in the next decade. But the implications of fully digitized medical records are staggering: no more row-upon-row of manila folders stashed in anachronistic moveable cabinets; no more suspenseful waiting on a diagnosis as tests slog from office to lab and back; millions of dollars of potential savings on labor-intensive paperwork.

However, some critics fear that some aspects of such a system could be equally dire: a loss of patient privacy, medical tampering, and lost profits in a health care financing system that doesn’t always reward efficiency. But proponents of sharing electronic medical records counter with another statistic: Information errors or a lack of data lead to as many as 100,000 deaths a year in the United States, according to estimates from the Institute of Medicine.

Easy information
Quite simply, the advances make medical care much better for patients today, said David Pecoraro, vice president and chief information officer at Louisville’s Jewish Healthcare Services. Pecoraro was a key player in creating Jewish Healthcare’s innovative Jewish Hospital Medical Center East, a futuristic model for the implementation of IT solutions in medicine today.

“We’ve built what we felt was the next generation of delivery practice,” he said, referring to the 210,000-s.f. facility that opened just over a year ago. “It’s easy to go with medical technology that has been proven. But with this facility, we built a system that was designed to look to the future.”

Jewish East, one of the health care system’s regional outpatient facilities, has blended the latest in medical advancements with pricey digital innovations to create a sort of outpatient laboratory that Jewish can implement piece-by-piece at its other medical campuses.

A wireless-capable operation, for example, has enabled doctors and nurses to use hand-held computers for in-room triage, registration and electronic patient and physician signatures. It also acts as a scheduling system for activities ranging from ordering medical supplies to scheduling transportation for a patient. The facility is dotted with video-on-demand audio and visual devices to help patients and their families keep tabs on what’s going on. Caregivers get wireless telephones. And an infrared tracking system eliminates confusion and frequent inquiry about a doctor or nurse’s whereabouts.

At the heart of every innovation at the medical center, though, is the paperless information system, where an online medical record is created for every patient.

“Building a paperless hospital was critical to our larger goal of attracting and retaining a leading team of clinicians and providing quality patient care,” Pecoraro said. One challenge “was finding a method to link different record systems and clinical applications to work together to complement and enhance caregiver workflow. Our design was such that paper causes us to be less efficient.”

The goal is for staffers to spend less time scrambling around an intensive-care unit for stacks of folders with patients’ records, and more time administering care. But perhaps the most revolutionary promise of digital records is allowing patients, who often feel they have little control in medical care, to stay connected.

“We’ve built access tools via the Web” that connect doctors patients anywhere on the planet, he said. “At Jewish Medical Center East, the key activities in that facility have to do with emergency medicine and with outpatient surgery. For each of those areas, we look carefully at the clinical records needed, and we look to find systems that allow us to be most efficient in handling communications.”

But wherever information swapping is easy, security is a concern. Some fear that patient privacy and confidentiality could be lost to the advance of file-sharing technologies. To protect medical information, administrators at Jewish East say that no data can leave the building except for approved medical protocols.

“We have this extensive wireless environment where doctors can access information on their handheld computers – any medical records, X-rays, whatever – that were done,” said Deborah Molnar, president and chief executive officer for the medical center. All data there is stored strictly at an on-site mainframe computer. “Jewish East was designed so that once the doctor leaves the facility, that information leaves their palm pilot,” Molnar said. The hospital also ensures that a firewall is in place at all times, preventing unauthorized access of any data in the system.

Officials at OLBH and Ephraim McDowell express similar concerns for patients’ privacy. James W. Meister, OLBH’s director of information technology, said a systematic review of confidentiality issues would accompany the influx of data-enhancing medical devices.

Sparking new ideas
As with most technologies, advancements in communications and data-sharing have spurred innovations in other areas of treatment. Administrators at Ephraim McDowell in Danville, for example, are focusing on medical diagnostics that can be digitized, enhanced and shared.

For a long time, “Ephraim McDowell Health dedicated itself to reaching out to surrounding communities for a population that previously was under-served,” said Robyn Pulliam, director of diagnostic services at the center, which serves more than 420,000 residents in 19 Central Kentucky counties. The hospital prides itself on utilizing the latest medical technology to treat underprivileged populations.

Just over a year ago, Ephraim McDowell installed an R2 Digital Mammography Film Checker that analyzes exam results via computer, locating regions of the breast that “look suspicious. The data kind of shines out and says, ‘Hey doctor, look right here, check this out,’” Pulliam said. “It’s a great development that provides an important tool for fighting breast cancer.”

In related fields, the medical center has latched onto the flexibility of digital imaging technology by sharing and storing data over the Internet. It’s in the midst of implementing the health system’s Picture Archiving and Communications System, called PACS, Pulliam said.

“PACS connects us anywhere in the country with a patient’s data,” she said. “Referring physicians have access to X-rays and other information as soon as it is prudent to share information.” Moving from film to stored digital images boosts the number of patient images that staffers can examine and cuts the costs of processing and storing x-ray negatives.

“We’re constantly upgrading our technology and equipment,” she said. “As with other technology, most medical technology can be outdated after five years, some even sooner than that.”

In Ashland, Our Lady of Bellefonte Hospital, a member of the Bon Secour Health System that has 24 facilities in several states, has enhanced radiological screening with a program called UltraRAD. The system creates an additional layer of examination for patients and stores data without film, adding operational efficiencies that have increased productivity 50 percent across the entire Bon Secour system, said Meister, the information technology director. He added that OLBH has recently transformed from a hard-wired computer system to a wireless, Web-based network, which sets the stage for a near-future adoption of hand-held, wireless PDA systems now being used at other Bon Secour health care facilities.

OLBH also has taken advantage of its Bon Secour network in the financial realm, where it is able to enhance the speed of communications between hospital, insurance provider and patient, allowing for a smoother flow in the payment cycle.

Progress, at a cost
The cloud over efforts to digitize health care systems, of course, is the tremendous investment required to upgrade and maintain new technologies. According to the Health Care Technology Institute, a nonprofit organization formed by the Health Industry Manufacturers Association, new medical technologies like devices, pharmaceuticals and procedures contribute between 11 and 15 percent of the annual increase in annual U.S. health care costs.

Experts agree it will cost hospitals around the country millions and private practices tens of thousands of dollars to upgrade to fully digital medical records. That’s quite an obstacle, considering a typical physician’s office has revenues of $250,000 and a technology budget of $10,000 each year, according to the Healthcare Information and Management Systems Society, an organization that promotes medical IT advances.

And the irony of a system that cuts waste and keeps patients with chronic illnesses out of the hospital is that it might save insurance companies money, but doctors and medical providers don’t necessarily stand to benefit. In other states that have pushed for paperless health care systems, critics have said there is little incentive for doctors to invest in such technologies when neither they nor their patients will see the savings.

Some industry analysts speculate the federal government might move to offer tax breaks or extra Medicare reimbursements to doctors who begin filing medical records electronically. But details of any such programs have been mentioned little, if at all, on Capital Hill.

Candace Littell, director of the HCTI, said the real culprits in health care costs in recent years have been inflation, health services price increases and population growth.

Jewish Healthcare Services’ Pecoraro argues that cost can’t always trump the quality of service provided. “It’s fair to say that each system we looked at, we analyzed the return on investment, measured in labor and supply savings,” he said. “We were willing to pay for outstanding performance and turn-around times, like having a radiologist being able to look at an x-ray right away,” instead of having to wait a day or two. “The bottom line is this: I can tell you we’ve spent many millions of dollars putting these technologies in place, but it all has a solid return.”

Returns aside, Pecoraro said that in the end, everything boils down to giving the patient the best treatment available. This system “helps people have a comfort and confidence in their healthcare,” he said. “What’s the next generation of medicine going to be like? It’s going to be the sharing of information and communication. That has been our marching drive all along.”

Dennis O'Connor is a staff writer for The Lane Report.
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