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Inside the November/December 2005 print
edition of Canadian Healthcare Technology:
Feature Report: Clinical decision support
Capital Health, Philips enter $70 million partnership
Just about everything about this deal is big,
especially it’s ultimate ambition.
Sunnybrook tests new patient-safety alert system
Dr. Bill Sibbald, Dr. Ed Etchells, Sherman Quan
and Sam Marafioti are leading Sunnybrook’s evaluation of a clinical
alerting system that will instantly inform care-givers when lab test
results are abnormal.
READ THE STORY
ONLINE
Hamilton portal for CCAC
A new web portal is allowing the Hamilton
Community Care Access Centre (CCAC) to securely share client
information with a variety of partners, quickly and easily, and at
relatively low cost.
Canadian medical centres forge ahead with Computerized
Physician Order Entry
Baycrest implements ground-breaking LTC system and
Vancouver Coastal Health aims for regional CPOE.
READ THE STORY
ONLINE
Virtual telehealth clinic
A private-sector company, Virtual Clinic Inc., is
providing nurse-led telehealth services using innovative
technologies. The nurses are trained in specialties like
occupational health and benefit from the support of physicians. Oil
industry customers have already signed on.
Interview: Jamie Bowie
An in-depth discussion with the CIO of one of
Canada’s most IT-intensive community hospitals, Credit Valley
Hospital in Mississauga, Ont. Jamie Bowie discusses the centre’s
approach to IT, and its current projects and priorities.
CHUM’s advanced OR
Centre Hospitalier de l’Universite de Montreal
(CHUM) has optimized its operating rooms so that new technologies
can be better implemented and used. The lessons learned will be
transferred to the upcoming super-hospital.
PLUS news stories, analysis, and features and more.
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Capital Health, Philips enter $70 million
partnership
By Andy Shaw
EDMONTON – Just about everything about this deal is big, especially it’s
ultimate ambition. The extendible three-year agreement means Edmonton’s
Capital Health, the country’s biggest academic health region, will
purchase $70 million worth of the latest digital diagnostic imaging and
monitoring equipment from Philips Electronics Ltd. – in return for a
number of benefits, including research, training, and education support
from Philips.
As such, it is the biggest equipment and service deal ever signed by
Capital Health, the largest signed by Philips in Canada since it first
began business here in 1934, and one of the most extensive alliances
ever struck in North America between a healthcare authority and a
supplier.
In the shorter term, Capital Health, Alberta’s biggest employer with
29,000 people on the payroll, will use the new gear to speed up the
integration of its Picture Archiving and Communications Systems (PACS).
The MRI and CT images conveyed by the PACS will be attached directly to
an individual’s electronic health record (EHR) in netCARE, the region’s
EHR system that will soon be available province-wide.
There’s an ambitious longer-term goal, too. The partners hope that in
the future, the regularly upgraded imaging equipment (and the imaging
research the agreement calls for) will allow physicians and other
healthcare professionals to catch patient abnormalities long before the
disease they portend strikes.
Big deal, indeed.
“As large as the equipment purchase part of the contract is, that is
just the beginning of our journey,” said Juoko Karvinen, chief executive
officer (CEO) for Philips Medical Systems worldwide.
Karvinen made his remarks at the Edmonton announcement of the agreement,
which was staged at Capital Health’s University of Alberta Hospital in
September.
“As a company, our mission is to improve people’s lives through
technology. And we share that vision with Capital Health. So our goal,
though it will take some time, is to go from the present care-cycle,
where diagnosis still often happens too late – from that, to actually
stopping a disease before the symptoms appear. That’s the ultimate goal
of our joint journey.”
It was that kind of vision that helped seal the deal with Philips, after
Capital Health spent three months reviewing competitive bids from other
global companies, said Capital Health’s president and chief executive
officer (CEO), Sheila Weatherill.
The nuts-and-bolts end of the deal covers purchases that Capital Health
will make (with federal and provincial financial assistance), of
Philips’ latest nuclear medicine, ultrasound, patient monitoring, X-ray/angiography
and fluoroscopy machines for its 13 hospitals and two community
healthcare centres.
The biggest ticket item on the shopping list is the Philips Gemini GXL,
a combo CT and PET whole body scanner, with a $3 million price tag.
“Patients will benefit because we can now regularly bring the best
diagnostic and monitoring equipment available to the front-line of our
care,” said Weatherill.
Alongside the medical benefits of putting such gear into action, Capital
Health has locked down the price of other purchases over the three-year
term of the deal, as well as two, one-year extension options.
This will help make top-of-the line imaging equipment standard across
the region. Also, the price predictability it brings, as well as a
streamlined purchasing process that eliminates the high cost of piece-by
piece-buying, will generate savings that can be applied in other areas.
But the deal does not mean that Capital Health’s hands are tied only to
Philips equipment.
“Our contract is structured to ensure that Philips keeps us on the
cutting-edge of technology. But should they fall behind in some areas,
we have an ‘out’ clause to go elsewhere,” said Joanna Pawlyshyn, the
chief operating officer of Capital Health’s Diagnostic and Equipment
Services. “So it will keep both parties on their toes.”
For Philips, the benefit of the alliance with Capital Health is more
than just a guaranteed cash flow.
“This strategic alliance provides us the opportunity to investigate
mutually beneficial opportunities in product research, and gives us
access to leading-edge physicians and researchers,” said Iain Burns, CEO
of Philips Canada.
Added Capital Health CEO Weatherill: “Our clinicians, scientists, and
technical experts will work with their colleagues from Philips on new
discoveries, new clinical trials, and other opportunities that will help
bring the best researchers and teachers to Alberta.
“We’ll become a lead test site working with Philips for trying out new
equipment and new technology.”
All of which, of course, will be digital.
“I think that’s also what should be stressed about this current deal,”
said John Cieslowski, vice president of sales and marketing for Philips
Canada. “Because all the images generated by the new equipment are
digital, that not only means they can be attached to an EHR, but it also
means the whole process of diagnosis and indeed much of Capital Health’s
workflow can be done more accurately and faster.
“That not only helps save costs,” added Cieslowski, “but it also
improves patient care, including the reduction of wait times.”
Sunnybrook tests new patient-safety alert system
By Laura Bristow
Sunnybrook & Women’s is the first hospital in Ontario to evaluate a new
software program, called New Age, for its ability to improve patient
safety by instantly alerting clinicians of abnormal lab results.
New Age is handheld software that will display Sunnybrook & Women’s
Electronic Patient Record data, including laboratory results, radiology
reports, admission and discharge information, and patient specific
transcription – all in an integrated fashion. The software is web-based,
meaning that all relevant clinical data can be accessed from any
internet browser within Sunnybrook & Women’s, including handheld devices
at the point of care. This program allows physicians to monitor a
patient’s condition in real-time and creates instant alerts that can be
sent wirelessly to the physician’s pager or cell phone if a potentially
serious lab abnormality or drug interaction is detected.
“Timely communication of abnormal test results is critical to developing
safe and reliable hospital systems,” says Dr. Bill Sibbald,
physician-in-chief of the Department of Medicine. “Adverse events are
prevented when physicians receive timely notice of a problem in its
earliest stages of evolution.”
With the current approach to notifying care providers of potentially
serious problems, there is a significant potential for error, as
information about test results must be communicated through at least
three people before it reaches the attending physician.
New Age’s automated system will significantly decrease the chance of
error by also sending an alert directly to the physician when a problem
is detected, and continuing to escalate the alert message until it is
addressed.
“The New Age trial is an important step for Sunnybrook & Women’s as we
move toward our goal of becoming the safest hospital in Canada,” says
Dr. Ed Etchells, primary investigator for the trial and director of
Sunnybrook & Women’s Patient Safety Service. “It shows that we are
committed to finding ways to improve our patient care.”
“The New Age system will also improve staff efficiency, as it can
automatically monitor patients’ conditions, while continuously scanning
for problems that meet predefined guidelines,” Sam Marafioti, vice
president, corporate strategy and development and chief information
officer. “Staff will be able to use the time saved to address other
high-priority concerns.”
The trial is being sponsored by Dr. Sibbald in partnership with Sam
Marafioti, and Corporate Information Services. The trial will be
conducted with one General Internal Medicine physician team and two of
Sunnybrook & Women’s Critical Care Units.
The evaluation team includes Dr. Robert Fowler, Dr. Mark Cheung, Dr.
Neill Adhikari, and Dr. Martin Chapman. Sherman Quan, health
informatician for the Department of Medicine, is leading the
implementation of the software, developed by New Age Systems Inc., of
Inglefield, Indiana. (www.newagesystemsinc.com)
The trial is scheduled to begin in the Fall of 2005.
According to the company, the New Age Systems solution is a clinical
decision support tool that harnesses the power of information already
captured in disparate computer systems. It detects potential ADEs before
they occur, and prevents them by triggering alerts to caregivers.
In this way, a healthcare organization will better utilize and
communicate knowledge, so that appropriate changes can be made in orders
without finger-pointing or blame.
Here’s how it works:
• Data is captured from HL7 interface messages, such as pharmacy orders,
laboratory results, and others.
• HL7 data is converted to XML.
• XML data is parsed into a database.
• Rules are applied against the data using Microsoft BizTalk.
• Patient safety alerts are triggered to clinicians.
Example: An alert will be sent to the ordering physician if a medication
order is received for the drug Flurazepam in a patient who is more than
65 years of age.
The alert will indicate that this patient is at risk for fall, and will
suggest that a change in dosage may be indicated or a less sedating
medication should be considered. In addition, this data will be retained
in a database, along with other relevant information about the patient,
such as data from the risk management incident reporting system
indicating if the patient actually fell.
This accumulated data is used to measure the effectiveness of the
alerting process (i.e., percentage of orders changed and correlation
with fall/no fall outcome), as well as other measures to identify future
opportunities for improving patient safety.
(For example, the correlation between fall risk score and actual falls,
actual falls correlated with types of medication patients were on, etc.)
Laura Bristow is a Communications Advisor at Sunnybrook and Women’s
College Health Sciences Centre.
Hamilton web portal allows efficient, secure
transfer of client information
By Leona Enns
HAMILTON, ONT. – A new web portal is allowing Hamilton Community Care
Access Centre (CCAC) to share client information confidentially with
health partners at the click of a mouse.
The Hamilton CCAC Web Portal, with licensing and development costs to
date of about $15,000, replaces the use of fax machines to transmit
confidential client information to contracted service providers and
long-term care homes, says Darlene Redfern, the Hamilton CCAC’s vice
president, Finance and Systems. “We’re very pleased with the improvement
in efficiency.”
Hamilton CCAC is mandated by the provincial government to connect people
in the community with health and support services at home. For people
who can no longer live independently, the agency is also the conduit for
admission to long-term care homes. Hamilton CCAC serves just under
10,000 Hamiltonians per day, and because information transfer plays a
key role in client service, the new web portal has proven highly useful.
The portal spares Hamilton CCAC from sending hard-copy documents, many
of them multiple pages, to multiple destinations by auto or manual fax,
Redfern says. The system also benefits service providers (agencies that
provide direct care in the home) and long-term care homes, which can now
gain access to transmitted information almost instantly by logging on to
the portal. In addition, unlike with fax transmissions, Hamilton CCAC’s
health partners can retrieve exactly the amount of information they
need, and in an electronic format.
Clients benefit most of all, Redfern says. The more quickly Hamilton
CCAC can transfer information to its health partners, the sooner care in
the home can be arranged, and the more rapidly long-term care
applications can be processed. And the more efficient Hamilton CCAC is
in its paperwork, the more dollars can be freed for client care.
David Cullum, Hamilton CCAC’s Information Technology (IT) director,
developed the system 18 months ago in conjunction with Creative Pursuit
of Burlington, Ont., a contracted IT development company. Recognizing
that Hamilton CCAC’s data transmission needed to become more efficient,
Cullum searched for existing technological solutions but found none that
matched his criteria. The new system had to deliver specified functions
while meshing with the Hamilton CCAC’s existing database, as well as the
databases of its health partners.
In conjunction with Creative Pursuit CEO Rene Estrada, Cullum decided to
create his own solution, and the new web portal is the result. Thirteen
of Hamilton CCAC’s contracted service providers have been using the
portal for the past year, Cullum says, and two others have joined more
recently. During August, 28 long-term care homes came on board. These
health partners use the web portal seven days a week, 52 weeks per year.
The Hamilton CCAC Web Portal is “incredible” for various reasons, among
them its extremely sophisticated security features, ease of use,
integration with the Hamilton’s CCAC’s client database, and future
capabilities, Estrada says.
The portal has various security levels, from an internal algorithm that
encrypts the user’s name and password, to database/web service
encryption, to a licensed certificate that provides a secure channel for
the transmission of information over the Internet, he says.
Users can retrieve, download and/or print exactly the information they
need, Estrada says, and some users have gone a step further to write
in-house software programs that automatically update their own databases
using critical client information extracted from the web portal.
Approximately 5,000 documents per month are transmitted and received
through the web portal, and the number is growing significantly, Cullum
says. Of these documents, about 80 percent are service orders the
Hamilton CCAC sends to its service providers. The rest are Resident
Assessment Instrument for Home Care (RAI-HC) files, which the Hamilton
CCAC sends to long-term care homes; and billing files containing over
one million transactions, which service providers upload to the Hamilton
CCAC upon service delivery.
RAI-HC files, which assist community care access centres throughout
Ontario in determining the health needs of adult clients, as well as
their placement urgency, are 18 pages each in length, making them
particularly cumbersome to transmit and receive by fax. The Hamilton
CCAC during the past year and a half has issued about 20,000 RAI-HC
files. In the future, supporting documents to RAI-HC files may also be
sent via the portal, Cullum says.
CarePlus is a Hamilton-based service provider under contract to the
Hamilton CCAC, providing clients with personal support, nursing care and
therapeutic services. Quality manager Dan Hickey says the web portal has
helped his organization a great deal. For example:
• CarePlus staff members no longer need to re-enter into their computer
system the information provided to them on faxed service orders from the
Hamilton CCAC. This eliminates duplication of effort and errors caused
by the incorrect interpretation of handwritten service orders or the
incorrect re-entry of typed information.
• CarePlus no longer needs to deal with faxes that are difficult to read
due to handwriting peculiarities or technical problems.
• Billing errors due to misinformation (e.g., spelling mistakes or
incorrect health card numbers) have been eliminated, because CarePlus
uploads billing files to the web portal based directly on downloaded
service orders.
• Staff members, who face enough challenges in direct client care, enjoy
the convenience of the new system. The frustration of dealing with
problems that relate to information flow is minimized.
• Information is kept secure, yet authorized staff access to it is
greatly improved. For example, CarePlus staff members who are on call
after hours and on weekends can access the files they need at any time.
Authorized users gain access to the portal with high-speed Internet
access and the Microsoft Internet Explorer browser, Cullum says. Users
have different levels of permission and roles within the system and
depending on the user’s log-on credentials, a different client interface
appears on the computer screen.
In the next few months, a Hamilton physician’s clinic will pilot the
portal, and another CCAC will go live with similar technology. Other
projects slated for the future include the development of an interface
with the health card validation system of the Ontario Ministry of Health
and Long-Term Care.
Canadian medical centres forge ahead with
Computerized Physician Order Entry
By Andy Shaw
Computerized Physician Order Entry (CPOE) is nothing
new. Though it may seem cutting edge now, it first appeared when the El
Camino hospital in Mountain View, California convinced the nearby NASA
space center and Lockheed Corporation to help the hospital develop and
implement the world’s first CPOE back in 1971.
What that system did then and what the immensely more sophisticated CPOE
systems of today do is, in short, place the physician more centrally in
the flow of care inside hospital walls. Specifically, CPOE in its basic
form:
• Enables doctors to enter test lab and other orders for patient care
straight into the hospital’s information system;
• Helps prevent medical errors by checking the dosage of medication
given by physicians or other caregivers to patients;
• Signals to physicians when patients have allergies;
• Gives doctors immediate electronic access to their orders, their
patients’ clinical data, and lab results, and thereby;
• Reduces the number of duplicate tests.
Moreover, as CPOE systems have benefited from the advancement of
information technology (IT) since the 1970s, they can now also:
• Display on one screen many different kinds of patient data, providing
the physician with easier, timelier access and assessment;
• Signal when a test is about to be unnecessarily duplicated;
• Automatically sound clinical alarms, not just for allergies, but also
for abnormal test results or unusual combinations of data;
• Generate costs for tests and medication as a guide to physician
decision making;
• Show links to studies and research related to the patient’s current
diagnosis.
It’s an impressive list of functionality and benefits, that most
research indicates makes CPOE and its heavy capital investment cost
worth it.
At the Children’s Hospital of Eastern Ontario (CHEO) in Ottawa, a
six-year study of a CPOE system installed in two medical wards showed a
drop in the medical error rate of 40 percent compared with wards using
hand-written orders.
A hospital audit at the Royal Victoria Hospital in Montreal indicated
that a CPOE system incorporating expert content and decision support
lowered prescription costs by 30 percent compared to regular paper-based
orders.
Studies of CPOE installations at American hospitals conducted by Harvard
Medical School physician/researchers, Rainu Kaushal and David W. Bates,
indicate CPOE systems have reduced medication-related errors at some
hospitals by as much as 86 percent.
The growing awareness in the United States of the potential value of
CPOE systems and other life-saving IT systems has prompted high-level
politicos, such as former House of Representatives Speaker Newt Gingrich
and Senator Hillary Clinton, to actively campaign for their
implementation across the country. Indeed, the state of California has
made it law that acute care hospitals deploy IT such as CPOE in order to
reduce medical errors.
In addition to its safety benefits, CPOE vendors and supporters cite the
system’s potential for lowering costs through more efficient use of the
hospital resources CPOE commands. It automatically integrates
laboratory, imaging, nursing, and medication records, supposedly
resulting in increased operational efficiency – though convincing
studies of CPOE’s cost-benefits in this way are much harder to come by.
But it is true that for over three decades, CPOE has been promising and
in many instances proving its healthcare value in other ways. Yet even
today, though the pace of CPOE deployment is finally picking up, its
penetration to the broad healthcare market is limited. Latest U.S.
statistics available say that not much more than 5 percent of hospitals
there have CPOE up and running. It is not yet fully accepted as part of
the inevitable healthcare landscape. So it continues to draw both
boosters and skeptics.
“CPOE has made a huge difference here at Baycrest,” says one CPOE
advocate, Dr. Paula Rochon, senior scientist, and a staff geriatrician
at the Baycrest Centre in Toronto. Home to over 800 seniors in its
hospital and nursing home, Baycrest is also a well-known research
facility associated with the University of Toronto. It was the first
long-term care facility in Canada to fully implement CPOE, with a
$500,000 investment in its new system that was up and running in late
2004. And that drew international attention.
“Our purpose was to develop a system that makes a difference in reducing
adverse drug events,” says Dr. Rochon. “We’ve just finished a study with
U.S. backing of our CPOE and we are now in the process of analyzing the
data. But it’s already evident that it is very much contributing to the
new culture of safety we’re developing at Baycrest. You can see
immediate benefits. For example, when doctors write the script, it is
automatically legible which it might not have been before, and it is
automatically complete. So you don’t have to make guesses about dosages
or how long a medication was to be given, or the time of day. It is now
all very clear.”
In addition, Rochon adds, the drug orders make their way instantly to
the pharmacist to review – with no danger of delay or loss along the
way.
The Baycrest study was considered such a landmark for North American
healthcare it received a grant from the U.S. Department of Health and
Human Services Agency for Healthcare Research and Quality. Dr. Rochon
lead the study on site and worked with principal investigator Dr. Jerry
Gurwitz of the Meyers Primary Care Institute of the University of
Massachusetts Medical School. Together they have been benchmarking how
effective CPOE is in not only reducing adverse drug events, but also how
cost-effective it is for a long-term care facility to install and
operate the system.
And cost has been one of the major knocks against CPOE since its early
space-age beginnings. And a reason for its slower than anticipated
spread.
“It is not just the cost of the CPOE systems themselves, even though
they are not cheap. It’s the amount of customization that usually has to
be done that makes them so expensive,” says John Quinn, senior
executive, and chief technology officer for the Health and Life Sciences
Services of the consulting firm Accenture. “From hospital to hospital
there’s a lack of standardization when it comes to clinical procedures.
So almost every aspect of the CPOE system you buy has to be finely
tailored to suit your particular hospital.”
Also adding to these adaptive costs, says Quinn, there is “zero” common
architecture on which to lay a CPOE system. Indeed, some parts of some
CPOE systems are so stubbornly unadaptable that it can be more
productive for a hospital to shut that particular module down
permanently – and buy a separate more adaptable sub-application.
And that’s not all the bad news about adopting and adapting CPOE. Some
physicians simply won’t adapt, nor adopt. Indeed, a band of mutinous MDs
back in the 1990s at the University of Virginia medical Center staged an
open CPOE revolt. They protested by placing their entire orders in the
“comments” section of their CPOE screens, and therefore not giving the
system a chance to automatically check for the right medication and
dosage.
More recently, a study of the CPOE system installed at the University of
Pennsylvania Hospital published in the Journal of the American Medical
Association in March of this year, suggests CPOE systems might actually
increase the incidence of 22 types of medical errors.
In a University of Pennsylvania news release, sociologist Ross Koppel,
PhD, of the Center for Clinical Epidemiology and Biostatistics at the
University of Pennsylvania School of Medicine was quoted as saying:
“Good computerized physician order entry systems are, indeed, very
helpful and hold great promise; but, as currently configured, there are
at least two dozen ways in which CPOE systems significantly, frequently,
and commonly facilitate errors – and some of those errors can be
deadly.”
In simple terms, it is easy to see how the ease with which a medication
can be selected in a CPOE system – by a mouse click rather than by the
labour of writing its name out – could mean clicking the wrong drug or
dosage by a momentarily inattentive user.
Possible enough, but the study itself should be viewed as only a
cautionary tale, say other experts. As Dr. Bates, now the lead national
patient safety expert for the Leapfrog Group for Patient Safety, has
pointed out, the Pennsylvania study “did not examine medication error
rates at the hospital before installation of the CPOE system to
determine whether the system increased or decreased the rates.”
Baycrest’s Dr. Rochon agrees there are other things to think about when
hearing of such studies. “In the old days, if there was something done
that was an error, you might never have known about it. It would not
have been automatically flagged as a discrepancy. So it is very hard to
know what the baseline of errors was before the CPOE system was
installed.”
With it installed, Rochon points out, the hospital first of all can be
aware that an error occurred and has a path it can trace to find out why
it occurred. It can then figure out how the circumstances causing it can
be rectified.
It is with such optimism that a number of other Canadian hospitals have
set off down the CPOE path with determination. As previously reported in
CHT, the University Health Network have geared up a full CPOE to support
its Patient Safety Initiative. Most recently, Vancouver Coastal Health (VCH)
announced in August that it is upgrading its enterprise clinical care
systems so that it has a standardized base for implementing CPOE
eventually region wide. Expected to be implemented at four main
facilities in 2006-2007, VCH will likely be the first in Canada and
among the first in the world to have a CPOE that functions regionally.
Long-time VCH supplier, IDX Systems Corp., based in nearby Seattle,
Wash., got the nod from VCH to carry out the upgrade. In August, IDX
announced it had completed the upgrade of its Carecast clinical system
at VCH. It was the second of two international successes for IDX. In
June, it had activated a similar system for the University College
Hospitals in the United Kingdom.
“It was very much our experience in Vancouver, where we were able to
adapt Carecast over the years, which led to our success in Britain,”
says Mike Raymer, senior vice president and general manager for the IDX
Carecast Operating Unit. “Thanks to support that Vancouver Coastal and
other authorities have from agencies like Canada Health Infoway, British
Columbia is very advanced in its readiness for implementing regional
systems like CPOE. And we’re excited to be involved, because we have a
25-year history of developing collaborative architecture.”
That collaborative experience will be more than welcome, says Vancouver
Health CIO Greg Feltmate, when it comes to implementing CPOE at VCH. “We
decided to walk before we run with CPOE for the entire region. A number
of our facilities are still struggling with their legacy systems. So we
are working with them over the next year or so to get them up to the
right level of readiness for CPOE.”
Indeed, ‘walk-don’t-run’ may be the best policy for all users.
“CPOE is not so much about IT as it is about change management,” says
Accenture’s John Quinn. “CPOE by its nature imposes changes in the
workflow of a hospital, so there are behavioural barriers you will
encounter, inevitably. People want to know whether CPOE is going to
speed them up or slow them down.”
Dr. Rochon at Baycrest couldn’t agree more.
“Putting in our CPOE system involved a whole team of people,” says Dr.
Rochon. “You have to think about not only how it relates to physicians
but also to everyone else downstream from them – to the nurses, to the
pharmacists, to the ward clerks, to the porters. Every decision we made
about our system had a spill-down effect. So you just can’t pick up a
CPOE application and install it from right off the shelf. Each group it
affects has to give a lot of thought to how CPOE will change and how
they would like it to change the work they do. So it was very much a
home-grown effort with a huge team that made our CPOE work.”
Making CPOE work, therefore, in a regional setting populated by
independently-steered hospitals, might seem insurmountable. But the
U.S.-based Quinn for one is both pessimistic and optimistic about CPOE’s
prospects for wider use.
“As long as the majority of healthcare providers remain independent as
they are in the United States, we’re going to be years and years away
from ever reaping the full benefits of CPOE there,” says Quinn.
One of those benefits, incidentally, would be the reduction of what
IDX’s Mike Mayer terms the high incidence of “boundary errors” –
medication mistakes made because one hospital’s system can’t talk to any
others.
But in Europe and Canada, Quinn sees a hopeful trend for CPOE in the
purposeful breaking down of those hospital boundaries. As the National
Health Service is doing for all of England, and as provinces are doing
here, there’s a push to build, if not common, then certainly compatible
IT infrastructure for their major regions – infrastructure that can
support and make electronic health records, CPOE and other helpful
systems ubiquitous.
“If you want that to happen for CPOE, then the best thing to do is build
your own common architecture,” advises Quinn. “Like they are doing in
the UK, as a large enough region you can tell the vendors to re-build
their systems to suit your architecture, not the other way around, as
happens now. Then what tends to happen is also a good thing. Your
supplier is no longer the vendor, but rather a systems integrator
becomes your supplier, and the vendor becomes a sub to the integrator.”
Even in the United States, Quinn says a dramatic turn of recent events
is cause for renewed hope for CPOE and its record keeping capacities.
“The hurricanes (Katrina and Rita) that hit Louisiana this year knocked
out the servers that were holding the immunization records for school
children, and of course the flood waters wiped out most paper records.
So that became a big problem when school officials were trying to
temporarily place those kids in schools in other states. That’s given a
big boost to the call for electronic federal registries and other
widespread systems like CPOE that are not dependent on just one PC.”
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