A bird in the hand: by implementing resources already available, healthcare organizations have streamlined workflow, reduced costs and improved outcomes for patients. (Clinical Information Systems).

Every few months, a magazine article appears introducing us to the next great information technology tool. It's always just around the corner--a panacea that promises to slash costs, improve workflow and revolutionize patient care.

While many exciting advances are, in fact, on the horizon, clinicians and IT managers today find ways to use currently available resources with favorable results. In many cases, the improved outcomes are from simple solutions, including implementation of an existing technology tool or moving a particular program from a network setting in a facility to a portable setting in the field. Here are some real-life examples.

Patient Education

Sometimes, clinical treatment of a patient is only the beginning. Every day, as many as 700 patients may be treated at Thomas Jefferson University Hospital in Philadelphia, and ensuring that everyone receives and fully understands post-hospitalization instructions can be a challenge.

"We used to have a fulltime patient education coordinator who pulled together specialty areas and created a large number of pamphlets. Our graphics department would lay the pamphlets out, we'd print them, and about every two years we'd update them," says Janet Paul, a clinical specialist at Thomas Jefferson University Hospital.

But what happens when the patient's specific need is not covered in the available stock of pamphlets? What if the treatment protocol has changed since the last update? In those cases, hospital staff often found it necessary to work without printed patient information and simply provide verbal instructions--not the most desirable solution.

With pressure to reduce costs resulting in progressively shorter hospital stays, patient education is an area of growing importance, but one with challenges. At most facilities, staff time is one of them.

"Unfortunately, we don't have as much time as we'd like to present information to patients," says Paul. "We work with our nurses to make patient education an early and important part of our relationship, so having printed information to hand out is very helpful."

But Thomas Jefferson University Hospital was faced with allocating budget to develop and maintain inventory on dozens of different pre-printed information sheets attempting to cover a wide range of situations, ranging from the severely injured in the emergency department (ED) to an individual needing attention from the facility's oncology units. To address the issue, the organization turned to an off-the-shelf technology tool called CareNotes from MICROMEDEX that allows clinicians to print one of more than 3,000 different patient care sheets on demand.

In most cases, patient education tools provide

more options for a facility that faces a variety of patient presentations and provide the flexibility to modify patient care protocol to match an individual hospital's requirements and preferences. The CareNotes product also features illustrations to help patients who may have reading-comprehension or language issues.

"We have performed a cost analysis, and this system is definitely cheaper than our old method of writing, designing and printing pamphlets," says Paul. "We would not consider going back to developing and printing pamphlets."

Access Available Every Day

"I don't give a second thought to the lights coming on when I hit the switch, and that's how I now feel about many of our information technology tools," says Stephen V. Cantrill, M.D., F.A.C.E.P. "The tools we have in place are simply part of my daily workflow. If they were suddenly gone, it would be as if the lights went out."

Cantrill is associate director of emergency medicine at Denver Health, a hospital and Level One trauma facility that provides access to quality preventive, acute and chronic healthcare for all Denver citizens, regardless of ability to pay. Each year, Cantrill and his staff may treat more than 50,000 patients in the ED. He has been working to integrate information technology into the practice of medicine for more than 30 years and is a leading advocate for the use of existing tools to enhance patient care.

"About 95 percent of what we see in the emergency department is somewhat routine. A lacerated finger is a lacerated finger," he says. "But on almost every shift, a doctor will see a presentation that he perhaps hasn't seen for 10 years, or even something he has never seen before. That's when clinical information really gives us a hand."

One example of using available information is in the area of toxicology. Clinicians at Denver Health's emergency department see a substantial number of cases of drug overdoses--some accidental, some intentional. They use the MICROMEDEX Poisindex System to quickly determine the issues to expect with a medication or other substance and immediately move toward treatment.

"In most cases, I don't need to wait for a consult with a toxicologist. I've got all the information I need right at my fingertips by accessing a nearby terminal," says Cantrill. "That eliminates the need for two doctors to work on a single case, and it allows me to provide a more informed diagnosis."

Cantrill has set up terminals throughout the ED to ensure that clinicians have easy access to technology tools and can make use of what's available. "We're not interested in just speeding the process, although that certainly happens. We're interested in improving the outcomes for our patients," he says. For example, by making the same poison database available on terminals in the emergency department as the one used by Rocky Mountain Poison Control (also part of Denver Health), clinicians have immediate access to the same information while keeping the poison control professionals free to take other calls.

"The key is to make information accessible to those that need it. By doing this, we're able to improve the outcome and, in many cases, reduce the number of professionals needed for each incident," says Cantrill.

Taking Information to the Patient

Sometimes, it's just a matter of getting information to the right place. Denver Health paramedic David Chenowith recently added a laptop computer loaded with drug information databases to the equipment he takes out on calls. It has made a big difference in his ability to quickly and accurately begin treatment protocol on patients during the trip back to the hospital, rather than waiting until the ambulance arrives at the emergency department.

"I have been on many calls for elderly patients, and they frequently remove their medications from the original bottles and put them in containers to remind them what day and time to take which medication," Chenowith explains.

While this is a good tool for the patient, it can be a hindrance to those attempting to administer treatment in the case of a possible overdose. When paramedics arrive on the scene to find an unconscious patient and an assortment of unlabeled medications, it's hard to tell what has been taken or even if the medication is the source of the problem.

By taking a laptop computer with a drug identification program on calls, Chenowith can now simply refer to the database and, in most cases, quickly know what medications are involved.

"Before I started taking the laptop with me, I had to call back to the hospital and describe colors and markings on medications so someone could research the drug and tell me what to expect," he says. "With the programs we can now put on the portable computer, we eliminate the need for two of us to work on one patient and, at the same time, the program gives me possible symptoms of an overdose so I can be proactive in treating the patient even before we reach the hospital."

Chenowith notes that the biggest advantage is the ability to anticipate what might come next for his patents. "With our old system, I often didn't know what drug was taken. Now, I cannot only find the drug quickly, but I also get information on what symptoms to expect so I can anticipate what to look for."

As we continue to look forward to the myriad of new tools and technologies that will continue to improve how we treat patients, we can have significant and immediate impacts on cost, workflow and patient outcomes by understanding what's already available and maximizing usage.

Jeffrey R. Reihl is executive vice president of Thomson Healthcare Clinical Solutions, which includes MICROMEDEX, in Greenwood Village, Colo.