Monday, May 7, 2007 
By Jeffery Kurz, staff

MERIDEN -There may be no underestimating the value of taking penmanship out of the equation, but computerized physician order entry offers many other advantages as well.

The initiative gives handwritten orders, which can include patient treatment and prescribed medications, the boot in favor of entering such information into a computer network. MidState Medical Center recently finished setting up the system hospital -wide, the result of an intensive two-year training period. It’s a major step toward the goal of a paperless hospital , say MidState officials.

“First of all, you can read what people do,” said Dr. Roz Everard, a MidState hospitalist, in an observation that acknowledged that physicians do not typically earn high grades for handwriting. But there was more behind her enthusiasm.

“The beauty is you can be anywhere,” she added. “I can be at home and read orders and follow up on results.”

Hospitals are increasingly pursuing high-tech solutions in the effort to reduce medical errors. A 1999 report by the Institute of Medicine, titled “To Err is Human,” estimated that across the nation anywhere from 44,000 to 98,000 people died each year because of medical mistakes that could have been prevented.

While there are several causes of such errors, the report concluded that they are not typically the result of individual or group recklessness, but more often caused by fault-filled systems and processes.

An automated entry system can help reduce medication errors, among the more common, by more efficiently cross checking for conflicts with other medications, conditions or allergies, for example. In general, an automated system also allows for rapid and convenient access to more comprehensive patient information. More efficient communication among those taking care of patients, including nurses, doctors and pharmacists, is also an advantage.

Automating the information hospitals deal with on a daily basis is a trend nationwide, noted Roberta Luby, assistant vice president of IT strategic process at the UConn Health Center, in Farmington. The health center is in the process of implementing computerized physician order entry hospital wide.
“I think most hospitals would consider it a must for the future,” said Luby.

“I think you’ll see that New England is probably farther ahead than the rest of the country in this,” she said.

All 29 of the not-for-profit acute-care hospitals that are members of the Connecticut Hospital Association “have either implemented or are in the process of implementing some form of computerized physician order entry, due to the improved efficiency and accuracy associated with the use of these systems,” said Jennifer Barrows, the CHA’s communications director, in an e-mail.

When MidState moved to Lewis Avenue nearly a decade ago, the hospital used the opportunity offered by a new building to set up the beginnings of an automated information system. “Over the last 9 years we’ve been building the infrastructure to get to the point where this real-time information about the patient is at the clinician’s fingertips,” said Linda Berger Spivack, MidState’s vice president for patient care services.

At MidState, there is at least one personal computer for every two patient beds, and in most cases the ratio is one to one, noted Jennifer Comerford, the hospital ’s director of information services. There are also computers on mobile carts, with wireless access to the same network that serves Vocera, a hands-free voice communication system used throughout the hospital.

But reaching the goal of such convenient access requires the extra effort of entering information into the system. There are medical centers that have experienced resistance among physicians to the changes required because, as Luby noted, entering information into a computer simply takes longer “than scribbling it on a piece of paper.”

While MidState has had some “reluctant travelers,” the hospital’s efforts have in general been embraced by physicians, said Dr. Harold Kaplan, MidState’s director of medical affairs.

When it comes to entering information, “there’s no question that it’s faster to do it the old-fashioned way,” said Kaplan.

“We did anticipate going into this that there would be some push back from physicians and some difficulty getting physicians to comply,” said Kaplan. “And we were really surprised that we had really very little of that.”

MidState’s intensive training included one-on-one work with doctors, lead by Claudette Genova, a clinical consulting analyst.

“Using computers offers such a benefit,” said Genova. For example, she said, if physicians “order a medication a patient is allergic to, the system will alert them.”
“A beautiful thing is that information is available to a physician in their homes, in their offices,” she said.

Such benefits go a long way toward convincing doctors the extra effort is worth it.

“Right now, the level of physician buy-in has been incredible, really remarkable,” said Comerford.

“Claudette Genova gets a lot of credit for that,” said Kaplan, “because she and her staff did this in a very physician-friendly way.”

Another point of potential physician pique is what’s referred to as “order sets.” Those are essentially a list of procedures associated with a condition or ailment, a kind of check list of care that is brought onscreen by the computer software. A hospital develops order sets according to its standards, and doctors can to some degree customize them. “You have to have that level of flexibility, because no two patients are the same,” said Spivack.

But they can still be regarded, derisively, as “cookbooks,” noted Kaplan.

“The dirty word has been cookbook, but cookbook isn’t necessarily a dirty word if the cookbook is good,” said Kaplan. Order sets, said Kaplan, “are, in the best sense of the word, cookbooks, but they allow for flexibility, just as a chef with a good cookbook will do.”

Such reservations help explain why MidState took time and care with training. The hospital went system-wide with computerized physician order entry in December. The Emergency Department was the last department to go online.

The next step toward complete automation of information for MidState will involve documentation made by nurses, said Comerford., and will likely include using computing equipment at the patient beside.

“The more we can automate the safer patients will be,” she said. “It’s just good stuff.”