BUSINESSWEEK ONLINE : DECEMBER 11, 2000 ISSUE
BUSINESS WEEK E.BIZ -- SPECIAL REPORT How E-Hospitals Can Save Your Life When hospitals computerize patient care, they drastically reduce errors--and costs Last December, Sheryl S. Alderton checked herself into Brigham & Women's Hospital in Boston for a lumpectomy, a common surgical procedure for breast cancer. Like all patients, Alderton didn't want to stay in the hospital longer than necessary. Thanks to a novel program run by cancer surgeon Dr. Yvedt L. Matory, she didn't have to. Two days after the procedure--and two days earlier than normal--Matory sent Alderton home, equipped with a Sony Vaio computer complete with a video lens and speaker phone. Twice during her first week home, Alderton booted up the Vaio and checked in with trained breast-cancer nurses, who looked at the incision while talking to her. When an infection developed during a bad snowstorm, Alderton set up an online appointment with Matory, who prescribed an antibiotic. Without the Vaio, Alderton doubts Matory would have been able to examine her at all, since she lives in a small town 2 1/2 hours from Boston, and all the major roads were blocked. ''This took a lot of stress off the surgery,'' says Alderton. ''I got more rest at home, and if anything, they were more responsive to my needs.'' The hospital hopes to set up similar programs for patients with congestive heart failure, asthma, and colon cancer. Most of the world's medical centers are still technologically challenged compared to banks, manufacturing plants, and dot-coms. But a few hospitals, such as Brigham & Women's and its sister hospital, Massachusetts General Hospital, boast staffs of doctors and clinicians who are using information technology to revolutionize medicine. Here, the paper records that were the hallmark of medicine are giving way to electronic medical records, which are instantly accessible and constantly updated. Doctors are entering their orders, from prescriptions to lab tests, into a computer system loaded with software that instantly catches errors. In the radiology department, old-fashioned films that can easily be lost are being replaced with digital images. Perhaps most striking, the Internet is being used to extend care far beyond the hospitals' walls, from Martha's Vineyard to Indonesia. The Brigham and the General, as they're known, are the cornerstones of Harvard Medical School and rank among the world's best hospitals. Yet even here, information technology has produced astonishing improvements. It has cut the frequency of serious medication errors by 55% and the number of overall medication errors by 81%, says John P. Glaser, chief information officer for Partners HealthCare System Inc., which owns the two hospitals. The Institute of Medicine has reported that such medical errors kill at least 44,000 Americans a year--more than the number who die from AIDS or breast cancer. And because medical mistakes are so expensive, Glaser figures the order-entry system alone saves the Brigham up to $10 million a year--a 10-to-1 payback on its annual cost. While such use of technology is hardly unusual in the business world, these hospitals ''are way ahead of the state of U.S. medical practice,'' says Erica Drazen, a medical informatics expert at First Consulting Group. Some 95% of the nation's physicians and more than 90% of hospitals still rely almost exclusively on inefficient paper systems. ''It is an outrage,'' says Dr. Russell J. Ricci, general manager of IBM Global Healthcare. ''If an airplane crashed every day because maintenance records were kept on paper, the government would insist operations be computerized.'' But because ''it is too emotionally unsettling'' to recognize hospitals are unsafe, he argues, ''the issue of how to use information technology to [improve] health care has not been [widely] addressed.'' To be sure, the cost and difficulty of converting to computer-based systems also has slowed adoption. One file apiece. The Brigham saw the potential more than a decade ago and began building its own internally designed system. In the early '90s, it started using a computer system to keep patient records and issue doctor orders for its 720-bed hospital, which annually cares for 40,000 inpatients and 700,000 outpatients. When the Brigham merged with the General in 1994 to create Partners, this system was extended to the other hospitals and physicians affiliated with Partners. It now includes 30,000 workstations in 150 different locations. Even so, because it was introduced incrementally, ''It has hardly blown the budget,'' says Glaser, who figures Partners devotes only about 3% of its outlays to information systems. The foundation of this system is the creation of an electronic medical record for every patient. Although the average U.S. patient has 11 medical charts, Partners ultimately hopes to have just one record for each of its roughly one million patients. And by February, ''we hope to be able to access all of these records over the Net,'' says Dr. Robert C. Goldszer, vice-chair of the department of medicine at the Brigham. The resulting gains in efficiency are enormous. While paper records are constantly misplaced and often poorly organized, the electronic record is both easier to use and always available. To protect patient confidentiality, users must enter an ID and password--plus a 6-character code that changes every 60 seconds--to gain access to records. That makes a huge difference in the Brigham's bustling emergency room, which sees 56,000 patients a year and has electronic records for 80% to 90% of them, says Dr. Ron M. Walls, chairman of the emergency department. He recalls a woman who arrived by ambulance alone, unconscious, and suffering from a high fever. With paper records, it would have been impossible to get the woman's history quickly. With an electronic record, ''we got a pretty complete picture in just two minutes,'' says Walls. The real power of the electronic record becomes apparent when it's combined with the Brigham's order-entry system. Computer-generated allergy warnings alone now change 60 orders a day at the Brigham. And that's just a small piece of how the system improves care. For starters, it eliminates the need to decipher doctors' notoriously bad handwriting, a major source of mistakes. It speeds care by immediately paging doctors when a lab test spots a dangerous condition. ''Before, I might not have seen the patient until the next morning,'' says Goldszer. ''But now I have a much better chance of heading off severe complications.'' And by suggesting equally effective but less expensive drugs, the system has held annual increases in the Brigham's drug costs to ''less than 5% a year for the last five years, vs. 13% to 15% at some health plans,'' says Brigham President Jeffrey Otten. Similarly, in Brigham's radiology department many tests are now scheduled over the Web. In part, that's made possible because Brigham has the nation's largest digital system for ordering, viewing, and archiving images. Thanks to the Web, it takes only 15% as long to schedule tests as it did previously, says Dr. Ramin Khorasani, head of information management for Brigham's radiology department. What's more, ''up to 30% of the radiology exams ordered by doctors are not appropriate,'' says Khorasani. Brigham's system slashes that by prompting doctors to follow its clinical rules. If a doctor orders an X-ray to investigate abdominal pain, for instance, the system would suggest a CAT scan as a better choice. And once the exam is done, the digital image can be viewed instantly by every involved doctor, without the delays and danger of loss that come with film. ''The Internet is profoundly changing the way we practice radiology,'' says Khorasani. It is extending the reach of other specialists as well. Take Dr. Gary R. Epler, the world's leading expert in Boop, a lung disease so rare that the average doctor sees just one case in a career. Epler has long drawn patients from all over the world. But to reach even more, Epler is setting up a Web site that gives patients information, helps them monitor their symptoms, and offers a chat room--''Booptown''--where they can talk with other victims. Turkey shoot. Partners Telemedicine is a similar but far more ambitious initiative to sell the services of specialists to 30 countries, from Latin America to Southern Europe and the Persian Gulf. The program allows doctors in foreign countries to submit cases over the Net and then obtain an expert opinion. In a recent case, a hospital in Istanbul submitted X-rays of a young man who had broken his leg. While the Turkish hospital had been planning to put the leg in a cast, a radiologist at Mass. General spotted a rare form of bone cancer, and brought the man to Boston for surgery. Without that ''he would have lost the use of his leg,'' says Dr. Joseph C. Kvedar, director of the program, which will handle 1,000 cases this year, up from 500 in 1999. Unfortunately, Partners can't actively market this service in most of the U.S. State laws prevent physicians from practicing across state lines, and insurance companies are loath to reimburse for telemedicine. Other barriers, from high costs to the conservative mindset of physicians, have slowed adoption of electronic medical records and order-entry in many hospitals. ''But after 30 years in this business, I think we are finally turning a corner,'' says First Consulting Group's Drazen. She predicts that the rate of adoption of e-health practices will accelerate. One reason: the business community is demanding it. In mid-November, a group of 60 businesses, including heavyweights such as Ford Motor Corp. and General Electric Corp., announced they'll send their workers to hospitals using computerized systems like those found at Brigham and the General. The two Boston pioneers may still be exceptions. But before the decade is out, health-care experts, doctors--and patients--are hoping they become the norm. By WILLIAM SYMONDS _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ BACK TO TOP					e.biz Contents for Dec. 11, 2000 issue RELATED ITEMS How E-Hospitals Can Save Your Life TABLE: The Electronic Hospital INTERACT E-Mail to Business Week Online

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