California Hospitals Reflect Successes, Challenges To Wired Health System

Hospitals nationwide are making steady progress in implementing key components of electronic medical records, according to the annual Hospitals & Health Networks list of the 100 “Most Wired” U.S. hospitals. Six California hospitals and health systems made this year’s list, out of 16 that applied. In many ways, these hospitals are reflections of the incremental progress, and the formidable barriers to the health sector’s adoption of new technologies. Here’s a look at California hospitals that made this year’s Most Wired list.

Scripps Health Takes Steady Approach To EMR Rollout

Last summer, San Diego-based Scripps Health System embarked on what will be a multi-year effort to design, build, test and install an electronic medical record system at each of its five hospitals and 12 clinics. Scripps, which applied for the Most Wired list for the first time this year, has laid the foundation for an EMR with a master person index of all patients treated within the health care system. Scripps Memorial Hospital Encinitas, Scripps Mercy Hospital and Scripps Memorial Hospital La Jolla have implemented the EMR. Scripps plans to gradually introduce the technology to its other hospitals, with the goal of completing the project by November 2005.

In the future, Scripps plans to integrate computerized physician order entry capabilities into its information system, although CIO Jean Balgrosky said she doesn’t intend to mandate that physicians use it. Instead, she plans to first introduce CPOE in an ED, where physicians are more eager to begin using the technology. The hospital system is also in the midst of evaluating options to install a bar-coding system, which would ensure that hospitals are giving patients the right medications in the correct dose at the appropriate time.

Palo Alto VA Scores with PACS

The Veterans Affairs Health System is no stranger to technology. As one of the most wired health care systems in the country, the VA has one of the most comprehensive electronic medical records. So it’s no small feat that the Veterans Affairs Palo Alto HealthCare System made this year’s 100 Most Wired list. This is the second time VA Palo Alto HealthCare, which includes three hospitals, has earned the accolade.

Part of what makes this California hospital stand out from the rest is its picture archiving and communications system, which allows physicians to operate in a completely filmless environment. The cardiology and the gastroenterology suites can transmit electronic records into the PACS, which also stores consent forms and advanced directives that are tied to HealtheVet, the VA’s electronic patient records system.

The VA Palo Alto also has a charting application and data collection engine that automatically collects, manages, displays and stores patient information for the intensive care units. A new feature, which is in the final stages of development, will allow simultaneous queries to all ICUs and incorporate data generated from multiple devices. Palo Alto also has a relatively advanced bar code medication administration system that includes drug interaction information to ensure that patients receive the appropriate medication, in the right dose, at the correct time. Pharmacy robots automate the drug dispensing process.

Sharp Takes Steps Toward Medication Safety

San Diego-based Sharp HealthCare, which has been on the Most Wired list every year since its inception, in 2004 adopted computerized IV pumps that help providers avoid over-or-under medicating patients. Sharp’s Chula Vista hospital also is testing a wireless system that allows staff to automatically download updates to the pumps and track data on any problems or issues. Sharp CIO Bill Spooner said he hopes to have the wireless pump capabilities rolled out to Sharp’s four hospitals by the end of the year.

Last year, Sharp began an ambitious project to implement CPOE in its hospitals. The system is designed to integrate hospitals’ clinical and pharmacy systems. But the installation, according to Spooner, is going a lot slower than he had anticipated. Sharp has an ongoing effort with physicians to develop the system’s order sets for common procedures, which has taken a long time. Spooner insists that when the system goes live, it can’t take physicians more time than the current paper-ordering process. He plans to test the CPOE system either late this year or in early 2005.

University of Arizona researchers plan to study Sharp’s CPOE project to determine if the technology can reduce errors in nonacademic, community hospitals. The project is funded through a three-year, $1.3 million grant from HHS that will examine CPOE systems at three Sharp HealthCare facilities.

MemorialCare Takes CPOE To Next Level

Long Beach, Calif.,-based MemorialCare already has CPOE at its five hospitals. This year, the hospital system is embarking on a project to improve the technology and implement a new clinical information system. MemorialCare, which has made the Most Wired list five times, is now designing, building and testing the system. Scott Cebula, vice president for information services for MemorialCare, says the new system will bring “much more integration” to the hospitals’ information systems. Saddleback Memorial Medical Center in Laguna Hills will go live with the system in 2006, with other hospitals to follow.

Memorial also has implemented a communications device that uses voice-recognition capability and operates via a hospital’s wireless network. The device clips to a clinician’s jacket or lab coat, allowing a nurse or physician to quickly communicate. Two Memorial hospitals use the system, with a third to implement it this year. Cebula said the device is “extremely popular” among caregivers. In addition, the hospital system has been busy implementing an upgraded PACS system and implementing a standard operating room management tool.

El Camino Tests Tablet PCs, Takes Wireless Turn

It’s no surprise that a hospital in the wired heart of California should lead the pack when it comes to adopting information systems. El Camino Hospital in Mountain View, which has made the Most Wired list two years in a row, has been using CPOE since 1971. This year, the hospital began a successful eight-week trial of Tablet PCs, which providers can carry with them as they make their rounds, El Camino CIO Mark Zielazinski said. Tablet PCs are flat-panel laptops that use stylus pens or touch-screens, rather than keyboards, for entry of data and commands.

The 420-bed hospital participated in a study with Oregon Health & Sciences University to determine the acceptance rate of hospitalists who used the devices. With the computers, providers wirelessly could access the hospital’s CPOE system or any other information source that could normally be accessed from nursing stations. Some of the hospitalists who were part of a medical group that used electronic medical records were able to access them from the tablets, which was particularly valuable when they saw patients in the emergency department. Hospital workers are now using about 100 tablets, and Zielazinski said he expects to introduce a few hundred more tablets, which providers will use this year to begin recording patient progress notes.

In the meantime, El Camino is leveraging its wireless capabilities to implement new technology applications. The hospital has started allowing the public to access its wireless network and let patients surf the Web from wireless connections. Zielazinski said the hospital plans to begin charging a nominal fee, probably about $3 for a 24-hour connection, for public access to its wireless network. Other projects include a plan to begin collecting patients’ vital signs data wirelessly and an expansion of its wireless hospital communications system.

El Camino also plans to continue a move to upgrade its existing CPOE system to a newer product. Zielazinski said the hospital had intended to go live with the system in early 2005, but a product delay has pushed back the date until October 2005.

Camp Pendleton Puts Focus on Safety, Patient Satisfaction

Naval Hospital Camp Pendleton has focused much of its energy this year on the dual efforts of improving patient safety and giving patients at the 123-bed facility increased access to information, earning it a spot two years in a row on the Most Wired list. The hospital has put all of its patient safety reporting applications online. Users can anonymously submit reports about errors or unsafe practices at the hospital, which has greatly increased the hospital’s understanding about how well it delivers care to its patients, CIO Colin Archibald said. Other patient safety measures include the installation of a pharmacy robot to reduce medication errors and deployment of computerized medication carts in some wards.

To keep hospital patients in touch with loved ones who are deployed overseas, the hospital has partnered with a foundation to establish a videoconferencing link. In some cases, soldiers in Iraq have been able to see their children born in the hospital via the technology. Camp Pendleton also has computers with Internet access for hospital patients.

The hospital plans to upgrade its CPOE system, which hospital staff began using three years ago. The system was supposed to be operational in July, but because it is part of the military’s Composite Health Care System II electronic health care information system, the system won’t go live until Feb. 14, Archibald said. The Composite Health Care System has suffered from some setbacks, and some hospitals have suspended its use.

In addition, Camp Pendleton is working with Microsoft to integrate the hospital’s disparate databases into a single point of entry for clinical and administrative data. Archibald said the hospital has also volunteered to be a test site for the Navy to demonstrate wireless devices.

More on the Web

The Hospitals & Health Networks “Most Wired” list is available online.

A report by the Center for Information Technology Leadership examining the adoption of ambulatory computer physician order entry systems among California physicians is available online. The report was sponsored by the California HealthCare Foundation.

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