TECHNOLOGY TO THE RESCUE.

Byline: Tim Christie The Register-Guard

In the not-too-distant past, when one of Dr. Jay Chappell's hospitalized heart patients had a problem in the middle of the night, a nurse would fax him a paper printout of the patient's heart rhythms.

It might take 15 or 20 minutes for the document to slide off his home fax machine, with a muddled image that was hard to read, he said.

Now, if he gets a call at home from a nurse at 2 a.m., Chappell logs onto the the hospital's encrypted Web site from his home computer, finds his patient's electronic medical record and looks at a clean, clear image of the rhythm strip. The Eugene cardiologist can quickly check the patient's entire medical chart and cardiac history, which helps him figure out what to do with the new symptom, he said.

This kind of change - transforming medical records from paper and film records to digitized bytes - is promising to remake the way medicine is practiced and reduce medical errors that kill tens of thousands of patients every year.

Both local hospitals are making major investments in technology so that doctors and nurses have accurate, timely and comprehensive patient information on demand.

McKenzie-Willamette Medical Center's corporate parent, Triad Hospitals Inc. of Plano, Texas, is launching a 10-year, $1.3 billion information technology project and has selected the Springfield hospital as one of three pilot sites for the project.

PeaceHealth, the parent corporation of Sacred Heart Medical Center, based in Bellevue, Wash., has been incorporating technology to improve patient care for years, officials said. And when it opens RiverBend hospital in 2008, it will have no storage space for paper or film records - all such information will be stored electronically.

"In the heart of health care today, the most important tool a physician can have is accurate, good clinical information to make a good clinical decision," said Michael O'Rourke, Triad's chief information officer.

"If you want to improve the quality and safety of care, you have to support a physician's ability to make the best decision every time they make a decision," said Dr. John Haughom, PeaceHealth's senior vice president for health care improvement. "To make the best decision, they have to have all the information they need, whenever and wherever they're delivering care."

The push to use technology to improve care stems in part from a pair of reports issued by the Institute of Medicine, an influential branch of the National Academies of Science.

In 1999, the institute reported that 44,000 to 98,000 Americans die in hospitals each year because of medical errors. Deaths from medication errors both in and out of hospitals caused more than 7,000 deaths a year. Most medical errors, the report said, result not from recklessness but from basic flaws in the way the health system is organized.

Because a doctor didn't know Drug A wasn't supposed to be taken with Drug B - or didn't know Drug B was prescribed by another doctor. Because a pharmacist misread a doctor's scrawl. Because a nurse gave the right drug to the wrong patient or the wrong dose to the right patient.

While critics have argued the IOM's numbers - extrapolated from two studies of hospital discharges - were exaggerated, no one disputes the report galvanized the medical community to act to reduce preventable medical errors.

In 2003, the institute followed up with another report that said the best way to reduce those deaths was for health care organizations to aggressively upgrade their information technology systems so that patient information could be collected and shared.

These systems should operate seamlessly as part of a national network of health information accessible by all heath care organizations, and should include electronic medical records, secure platforms from the exchange of information among providers and patients, and data standards that make health information uniform and understandable to all, the report said.

McKenzie-Willamette technicians are laying the foundation now for their piece of Triad's IT initiative. Triad signed contracts last month with Perot Systems Corp. and

McKesson Corp. to automate clinical, financial and administrative programs at its 49 hospitals in 15 states.

Triad picked McKenzie-Willamette as one of three pilot sites because its leaders, administrative and medical, were ready to embrace new technology, O'Rourke said.

"They are going to be one of the first hospitals in the Triad organization to deploy and use these clinical tools in production," he said.

Chappell, who heads McKenzie-Willamette's Physician Leadership Group, said doctors there have been lobbying administrators to upgrade the facility's technology in recent years, and the hospital was making progress.

Triad first has to lay a foundation of hardware and software - computers, servers, hospital-to-hospital networks, handheld devices, tablets, laptops, computers on wheels - as well as training a staff of IT professionals to support that foundation around the clock, so the technology is available when physicians need it.

When a patient is in the hospital, they generate a lot of health care information, from lab results to medications to doctors' orders. The purpose of all that technology is to get "the right information at the right time to the right person about the right patient," O'Rourke said.

To do that, nurses will collect information about a patient at bedside and enter into an electronic medical chart using a computer on wheels or a tablet computer. That way, other health providers in the hospital have access to that information right away.

Nurses and doctors also will be using an electronic medication administration record, which keeps track of the different drugs being prescribed for a patient, and clinical alerts, which flag any medications that shouldn't be used together.

Patients will have bar codes on their bracelets, which can be checked against their medication bar code to make sure the right patient is getting the right dose and the right prescription.

Technicians will lay the foundation in coming months, and on Nov. 1, McKenzie-Willamette plans to go live, turning on 20 new computer systems, spokeswoman Rosie Pryor said.

PeaceHealth has taken a different route.

The health system, which operates six hospitals in Oregon, Washington and Alaska, is far smaller than Triad, the nation's third-largest for-profit hospital chain.

In 1994, it began building a "community health record," which includes not just a patient's hospital records, but also any place the patient comes in contact with the health system, such as a doctor's office or a nursing home, Haughom said.

In Lane County, where PeaceHealth operates three hospitals and a 100-physician medical group, 1.5 million patient records are in the system, which are accessed by thousands of health providers every day, he said.

The system also allows patients to interact with the health system. For example, in a program that began at PeaceHealth Medical Group's south Eugene clinic, patients can log on to a Web site to take care of many front-office services, such as registration, prescription refills, appointment and referral requests, as well send e-mails to their doctor.

About a year ago, the program was expanded so that patients could log on and view their own medical record, Haughom said.

Currently, PeaceHealth has physicians in two pilot programs doing their orders electronically.

"It's important because you have to get doctors to enter orders electronically so the computer can mine all that information," he said. "That moment when the doctor writes an order is when you have the greatest power to improve quality of care."

When PeaceHealth opens Sacred Heart Medical Center at RiverBend in 2008, the 859,000-square-foot facility will not have any storage space for paper or film records, Haughom said. All that data will be stored electronically, he said.

Computing will be wireless and mobile, with doctors and nurses using PDAs, laptops, tablets and computers on wheels to track patient care.

PeaceHealth spends about $25 million a year on advanced IT at all its facilities, including $10 million to $12 million for Sacred Heart and RiverBend, Haughom said. In addition, $60 million to $65 million is budgeted for one-time technology purchases at RiverBend, he said.

The next big advance in the IT evolution will bring patients' individual genetic codes into the mix, he said. Researchers are now about to put an individual's entire genomic code on a computer chip small enough to fit on a credit card, he said. That information can be used to tailor drug treatments to the patient's disease, he said.

Such genomic applications are probably eight to 10 years away, Haughom said.

CAPTION(S):

Dr. Thomas Macha, Orthopedic Healthcare Northwest, PC, studies CT chest scans off a Picture Archival Communication System. A CT pelvis scan from the Picture Archival Communication System.