Hiring an M.D. for the job may have been one of Hackensack's canniest decisions. Burns's degree gives him instant credibility with the physicians as he prods them to use the hospital's fast-evolving tech systems. "You have to be part diplomat and part hard-ass," says Burns.
Working from a windowless office in Hackensack's tech department, Burns has three or four basic jobs. He evangelizes technology to doctors. He personally reviews the electronic orders doctors place and coaches those who don't get it quite right. And he translates complaints from doctors about hard-to-use technology for the tech group so it can fix them.
The most important part of his job, though, is marshaling data to help the administration improve care. This practice, called informatics, is a touchy business because it typically involves midlevel administrators gathering stats and then trying to use them to get doctors to change their habits. At most hospitals, the bean counters get sent back to their cubicles, thoroughly chastened. Besides being a doc, Burns, whose title is director of medical informatics, has the advantage of being on Hackensack's medical board, the hospital's top medical policymaking body. "He probably has more influence than anyone at the hospital because he works with every department chair," says Chief Medical Officer Dr. Peter J. DeMauro. "They know he has my support."Slicing, Dicing
Follow Burns around, and you see how fast plans are moving. He holds tech briefings for doctors and sits in on sessions held to review patient cases. One of his duties these days is helping to pore over the data from Hackensack's procedures in orthopedics, medication management, and pneumonia. This task is being prompted in part by the Medicare pilot program to track hospitals' quality of care and then pay more for better care. The Medicare data highlight things Hackensack may do sloppily, such as not giving pneumonia patients flu shots or being less than vigilant about documenting infection control in orthopedics. Burns slices and dices the stats and then tries to help docs and administrators find ways to tighten up.
Collecting data lets Hackensack look much more closely over doctors' shoulders -- something they don't always like. Take his pet program: rolling out a procedure called multidisciplinary rounds, or MDRs. These rounds are daily reviews of each patient in a nursing unit, conducted by nurses, case managers, social workers, and an in-hospital doctor. In some units, teams use Lifebooks, which are wireless laptop PCs, to pull up patients' vital signs, doctors' notes, and lab tests from the hospital's central system. They can prescribe drugs or even recommend a patient be discharged, a dramatic step since doctors traditionally control such decisions. The hospital raised the ante this winter with a policy that temporarily suspends doctors from handling cases if they repeatedly ignore the MDR team's recommendations.
That sparked one of the few signs of rebellion at a hospital where the administration has moved gingerly to avoid spooking doctors. "People are irate over this," says Judith C. Gellrick, a kidney specialist, during one early-morning MDR meeting. But the meddling is producing results. Since 2001, floors using Lifebooks in MDRs have slashed the average length of patient stays by 24%. And readmissions for the MDR floors, a good gauge of whether patients are being sent home safely, dropped 12% between 2002 and 2004. "MDRs are probably the biggest contributor to the improvements in quality that we've made," Burns tells the group.
Crunching data instead of patching bones may seem like a sharp turn. But as hospitals get wired, they're showing that cold data can help patients as much as surgical heroics. "If people ask me, 'Don't you miss being part of a team that saves lives?' I say, 'I still do [save lives], but in a different way,"' Burns says.
That is the hope of health-care organizations across America. They're stepping up tech spending, betting that it will prove an antidote to spiraling costs, while improving care. Thousands of lives and billions of dollars are at stake. Hackensack is just a start. The future is taking shape, one digital hospital at a time.