|
VA Watchdog Stuff...
cups, hats, shirts...
click on item to order
and support the site.
Be sure to get all four
VA Watchdog dot Org
RSS feeds --
Daily VA
News Flashes
House CVA
Veterans' News
Senate CVA
Veterans' News
VA Press
Releases
Download your
free copy of the
2008 VA benefits
handbook here...
|
Printer-Friendly Version
HOSPITAL OF THE FUTURE? -- Despite progress toward
the digital hospital of tomorrow, VA and military
planners
are still grappling with the technical problems
of today.
Story here...
http://www.govhealthit.co
m/print/4_20/features/350522-1.html
Story below:
NOTE: If you wish to post a comment,
go to the end of the story and use our new "Comment"
feature.
-------------------------
Hospital of the future
Peter Buxbaum
When military health care planners say they are building the hospitals of
the future, they are referring to having state-of-the-art health
applications and practices — such as clinical decision support and
e-prescribing — hard-wired into the hospitals’ workflow.
However, it remains to be seen how close planners come to creating true
digital institutions in which medical and business information is
integrated and available to all the departments, clinics and service
offices that constitute a modern hospital.
Consulting firm PricewaterhouseCoopers described that vision in a recent
report. “The digital hospital goes beyond advanced clinical systems and
includes significant additional integration between medical and
information technologies that have historically been beyond the scope of a
hospital’s information technology strategy,” the report states.
Will the Defense and Veterans Affairs departments achieve that vision?
They certainly plan to make big improvements.
The VA Medical Center in Orlando, Fla., and the DOD hospital planned for
Fort Belvoir, Va., will be built with larger private rooms, family
visiting areas, hidden cabling for medical devices, acoustic flooring to
absorb noise, and personal wireless devices and Internet connections so
patients can keep in touch with loved ones or pass the hours on the Web.
Those features are designed to make a patient’s stay healthier and more
pleasant.
When it comes to clinical health information technology, most VA and DOD
hospitals are well ahead of the civilian health care industry. For
example, computerized physician order entry systems, which automate lab
and prescription orders, have long been commonplace at military health
facilities.
“You can’t find a prescription pad in any of our hospitals,” said Robert
Foster, program executive officer and deputy chief
 information
officer for operations, support and acquisition at the Military Health
System. “This cuts down on errors because physicians’ handwriting is so
often illegible. This hasn’t been implemented much in the civilian sector,
yet we’ve been doing it for 15 years.”
VA and DOD also use bar codes to track patients and medications and mine
their vast data repositories for disease surveillance and clinical
practice research.
Many DOD hospitals are also equipped with some of the most sophisticated
surgical technology available. For example, robotic surgical systems
combined with high-resolution video feeds enable surgeons to perform
operations remotely.
What’s a digital hospital?
But the benefits of such technologies
have mostly been felt at the departmental level. Pharmacy operations have
improved; lab testing processes have been automated; the surgical theater
is a technical marvel. Yet the fully digital hospital remains elusive.
That seems no less true today than it was three years ago when
PricewaterhouseCoopers studied the issue.
In the firm’s report, analysts painted a portrait of a digital hospital
that “comprises a completely automated and deeply integrated set of health
information services capabilities that fulfill clinical, financial and
administrative requirements. The common elements are core technologies and
automated processes.”
Most facilities lack such elements, and even military hospitals have not
reached a level of automation that would qualify as digital under that
definition.
“A digital hospital cannot be purchased off the shelf,” the report states.
“Implementing the digital hospital concept requires the integration of
many subsystems. Substantial benefits may not appear until a sufficient
level of automation — a tipping point — has been reached.”
Re-engineering health care
Military hospital planners say they
recognize that their facilities are not tightly integrated. They also
understand the scope of the effort. Officials at the Veterans Health
Administration are after nothing less than a wholesale re-engineering of
VHA’s health system, said Craig Davis, CIO at VA’s Orlando facility.
To do that, the military must solve the perennial problem of exchanging
patient data. VA and DOD struggle to share information at a global level,
but problems also crop up within individual hospitals, which frequently
treat the same patients.
The first challenge is figuring out how to automatically upload data from
radiography, laboratory and other clinical systems into an electronic
medical record. The next challenge is transferring data between the
departments’ EMR systems.
“The lack of data standards is an endemic problem,” Foster said. “Health
care organizations are having difficulty moving data from one place to
another because the data means different things to different systems. To
pull all of that data together, we need to migrate to agreed-upon
standards.”
Industry groups have made some progress in pushing for interoperable data
standards among clinical systems and EMRs. Health Level 7, a technical
standards organization, is developing sets of standards that systems
operating in a service-oriented environment can use to conduct
transactions with one another.
The ultimate goal is to improve treatment results, which means the real
challenges facing the military hospitals of the future will likely be
financial and organizational.
“We must maintain a focus [that] is outcome-driven rather than
technology-driven,” Foster said.
Adopting technologies that meet that goal will involve changing workflows
and processes. “Staff will need to change the way they work — possibly
dropping older systems and adopting specific work processes designed to
maximally exploit the capabilities of a given system,” the
PricewaterhouseCoopers report states.
That might be easier said than done. “Many of our senior, more experienced
clinicians may never have learned how to use a computer,” Foster said. “If
you throw technology at them, it is very challenging for them to adopt.
But we can’t leave them behind because their clinical knowledge is
extensive.”
The situation could improve as older clinicians retire, but providers must
still be persuaded to adopt the available technologies, Foster said. “It
doesn’t do any good to have an automated appointment system if providers
are not utilizing it,” he said. “There is definitely a gap…in the ability
of end users to adapt to technology.”
A continued focus on patient outcomes will help, Davis said. “Medical
errors cost $25 billion annually,” he said, but the ultimate return on
investment in health IT will be improved patient care and safety.
-----
Ahead of the tech curve
In some cases, hospital planners at the Defense Department have gotten too
far ahead of the technology curve. For instance, after installing passive
radio frequency identification systems, several military hospitals
experienced problems when they decided to move to more sophisticated,
active RFID systems.
Passive RFID tags have no power source; they acquire energy from the radio
signals used to read them and must pass through an RFID gateway to be
read. But active tags have a built-in battery, enabling them to be read
from farther away. In several cases, the active RFID tags interfered with
the operation of nearby medical devices.
Moving to active RFID presented “unintended and unforeseen consequences,”
said Clay Boenecke, chief of capital planning at the Tricare Management
Activity. “Sometimes you introduce a technology to make one procedure
better, but it complicates something else.”
Luckily, those complications were discovered during a pilot project, so
officials had the opportunity to experiment with the active tags and tweak
the frequency and duration of their signals to minimize problems
elsewhere.
Boenecke said DOD will likely use RFID technology for security in neonatal
units, among other applications. “The hospital could automatically be
locked down if a baby is carried off beyond where [he or she] is supposed
to be,” he said.
The technology could also address management problems — from asset control
to patient security — but its full potential for health care applications
lies in the future.
“The technology is still not quite as mature as the vendor community would
have you believe,” said Robin Portman, a vice president at Booz Allen
Hamilton.
“One question is how many readers you need,” she added. “If you need one
in every room, it is not going to make sense. That is the kind of
technical issue RFID is still up against.”
— Peter Buxbaum
-------------------------
TIPS FOR POSTING:
Comments should be about the story on this page. Respect others who
have posted. If you have a question for VA Watchdog...
go here...
-------------------------
posted by Larry
Scott
Founder and Editor
VA Watchdog dot Org
Don't forget to read all of today's VA
News Flashes (click here)
Click here to make VA Watchdog dot Org your homepage
email Larry
(go
back to VA Watchdog dot Org Home Page) |
Military
Medical Malpractice
Legal
Network
VA Watchdog Stuff...
cups, hats, shirts...
click on item to order
and support the site.
|
