With patient safety becoming an increasingly dominant theme for Duke University Health System, officials are looking to upgraded technology systems to improve safety and quality of care.
The impetus for the improvements of Duke's information technology system stems from the realization two years ago that if DUHS did not effectively revise its IT system, it would struggle to maintain patient safety and its reputation as a cutting edge institution.
Although other factors, such as installing a proactive culture, will have an impact on health care, IT will play one of the most significant roles.
"The adoption of information technology is at the core of health care," said Asif Ahmad, chief information officer of DUHS. He said medical school curricula do not teach how to optimize software and integrate information technology into providing patient care.
Foremost among the changes is next year's gradual implementation of the Computerized Physician Order Entry system, which will allow physicians to prescribe medication into a computer to streamline delivery and to avoid errors due to illegible handwriting.
"CPOE is not just for drugs," said Dr. Gary Stiles, chief medical officer for DUHS. "It also has clinical decision support systems built in."
The comprehensive system is set up to go through all patient information and highlight salient characteristics, he added.
Many similar CPOE systems have failed throughout the country, including those at the Johns Hopkins Medical Center, the University of Michigan Medical Center and Cedar Sinai Hospital in Los Angeles. Although DUHS has purchased the main framework of the system from an independent vendor, it is being customized to reflect the way DUHS operates, Ahmad said.
"Right now, 99 percent of physicians don't interact with a computer when they prescribe drugs or run tests," Ahmad said.
"Caregivers are so strapped for time that we need to make sure the system handles the complexity of multiple orders at a time." He added that one of his main goals was to add the "smarts" into the system, to catch potentially harmful drug interactions that might escape physicians.
To further prevent medication errors, all physicians will receive a Palm-based pocket personal computer that will contain information about drug formulations.
Dr. Karen Frush, chief medical director of pediatric services, said Duke University Hospital is currently switching over to a simple order entry system while it awaits the DUHS-wide implementation of CPOE. The simple order entry system is causing a significant volume of medication errors and delays of therapy, she said.
Although CPOE promises to revolutionize the way in which medication orders are processed, the system also hinges on various departments within and branches of DUHS--including DUH, Raleigh Community Hospital, Durham Regional Hospital and outpatient clinics associated with Duke--having one mainframe system for information such as medical records. Currently, the departments are set up as "small silos" with separate systems. Ahmad's plans include merging the systems into one comprehensive database that will allow for information retrieval by a broad spectrum of hospital staff--the eBrowser system. The system will also prioritize results to physicians so they cannot miss lab results or other diagnoses.
"Care is always very complex," Frush said. "To have all the information at a time of the visit can be very helpful."
In conjunction with eBrowser, the hospital is also implementing PACS--picture archiving and communication system--which will allow physicians to access radiology data on their patients regardless of their location, and will also enable multiple access simultaneously for physicians. PACS will cost over $10 million, but Ahmad said that it should pay for itself in the next two and a half years.
Additionally, the system will also save residents 7,000 to 10,000 hours per year, a critical need due to the recent implementation of the 80-hour work week for residents that was mandated by the federal government.
Although Duke passed the June deadline for the 80-hour work week unscathed, The Johns Hopkins Hospital lost its accreditation due to its inability to cope with the new restriction, which created an additional impetus to retool technology systems.
"The work now [has] to be produced by someone else," said Chair of Medicine Dr. Pascal Goldschmidt, adding that the hospital must invest in time-saving techniques, such as PACS, as well as human resources solutions to make up the loss of work.
When DUHS appoints a patient safety officer--an imminent move--one of this person's main goals will be to advance technology further, Stiles said.
Get The Chronicle straight to your inbox
Signup for our weekly newsletter. Cancel at any time.