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It's a chilly February morning, and Dr. Lauren Koniaris is hustling down the hall at Hackensack. She stops in room 9001 and finds her first problem of the day: Patient Dawn Tribuzio, 62, complains that her skin has felt itchy ever since she started taking penicillin to treat a flare-up of sarcoidosis, a disease that causes inflammation of the lungs. Koniaris rushes to a computer in the corridor and pulls up Tribuzio's electronic chart. It doesn't say she has a problem with penicillin, but this is her second reaction in recent weeks -- a sign she may be developing an allergy. Koniaris clicks through a series of drop-down menus to cancel the antibiotic and order anti-itch cream. Then she makes a note of the allergy in Tribuzio's electronic record so the hospital won't prescribe the antibiotic to her again. "Now the pharmacy knows forever," Koniaris says.
At 4 feet, 11 inches, Koniaris may not stand out in a crowd, but she's a giant in Hackensack's battle to go digital. A lung specialist who's in private practice just a block from the hospital, she has entered more than 120 medication orders into Hackensack's central system since January, making her one of the top five users. Dr. Gerard A. Burns, who's responsible for persuading Hackensack's doctors to use technology, counts on early adopters such as Koniaris to convince doctors still wedded to their pens to start ordering drugs and lab tests on PCs.
Getting doctors to go digital is one of hospitals' most urgent goals. Unless physicians use the central system for patient records and prescriptions, they won't get instant warnings about dangerous drug interactions, and hospitals won't be able to collect data needed to improve care. Yet doctors have resisted attempts to get them to use digital devices. They have griped that the technology was clumsy or slow or put patients on edge.
What has made the difference at Hackensack is its ability to foster dialogue between doctors like Koniaris and techies like Burns. It's time-consuming, and the exchanges can be heated. But they bear fruit. For example, when the e-prescription system was launched, Koniaris complained that the software forced her to slog through too many screens and enter information about patients that really wasn't necessary. "She'd send me notes that said, 'This sucks. Fix it,"' says Burns. "And we did." Now the e-prescribing mirrors how doctors normally prescribe drugs -- all it takes is a few clicks to order what they need.Hallway Monitors
Another time, Burns lent Koniaris a pocket-size PC, hoping she would carry it on her rounds and enter orders right from the rooms. But she felt it hurt her bedside manner. "It takes my focus away from patients when I have so little time with them already," she says. So Burns stopped pushing the pocket PCs. Instead, the hospital ensures there are enough PCs in the halls.
Spend a day with Koniaris, and you quickly realize that her biggest problem is a shortage of time. A 38-year-old mother of two, she's a whirlwind of multitasking. So technology that can save her time is a godsend. One reason she likes using PCs to order medicines is that she can see right away when she signs on what prescriptions need to be refilled, instead of taking several minutes to page through paper records to get the information. She logs on to Hackensack's Web site to sign off on patients' records because it saves her from waiting for the hospital's snail-like elevator to take her to the medical records department.
For Koniaris, the minutes saved translate into more time to spend with patients. It's not a benefit that she measures in dollars. Nor do patients perceive a direct link between technology and the quality of care. But patients like Tribuzio do notice the small blessings of being treated by a doctor who isn't constantly tied up in an administrative muddle. "I call Dr. Koniaris, and she calls me back in 10 minutes," Tribuzio says.
Technology may save doctors time, but it also could cost them some control. Digitizing all these data means hospital administrators have access to information they can use to second-guess doctors' decisions. Koniaris is well aware that Burns is getting together with other hospital staff to review medical records on his pocket-size notebook computer to try to determine which patients might be able to leave the hospital sooner than their doctors think they should. The Harvard-trained doctor doesn't appreciate the micromanagement. "They call me all the time and ask, 'Why is this patient still in the hospital?"' she says. "The pressure is intense."
Back at the hospital, Koniaris has discovered her second penicillin mixup of the day. Patient John Mahony, 83, is allergic, but the doctor who admitted him put him on it anyway. As Koniaris switches him to a different antibiotic and says goodbye, Mahony asks: "How long am I going to be in?" Koniaris makes no promises. Still, with technology on board to keep medication errors from befalling Mahony, he may be home sooner than he thinks. That's an outcome sure to make the hospital as happy as it makes the patient.