A smoother operation at the digital hospital
David Veillette, chief executive officer of the Indiana Heart Hospital, was shocked to realise he had overlooked something when the hospital he had planned so carefully opened two years ago. Amid all his care over the revolutionary all-digital hospital, he had forgotten rubbish bins. He ran to a home improvement store and bought every bin for the 88-bed, 210,000 sq ft hospital.
The oversight revealed the contempt for paper held by the man who had completed a new, virtually paperless hospital, running on integrated computer systems.
At the Indiana Heart Hospital digital information networks are used in admitting and treating patients, and maintaining their records. The hospital has become one of the first “true digital hospitals”, according to PWC health research, by integrating information networks and medical technologies. The hospital is also a pointer to the future for important national healthcare information technology projects. It is a small-scale version of the potential offered by the UK National Health Service's ￡6.2bn project to create a centralised digital national healthcare system. This will include internet patient appointment booking, primary and emergency clinical care, mental health and community care.
In the US, with its fragmented, private healthcare system, President George W. Bush has pushed for a more humble goal. He wants electronic medical records, the backbone to any integrated digital healthcare system, available for all Americans in 10 years. Mr Veillette says: “This is what healthcare needs to look like in the future . . . We're just the beginning.” At the Indiana Heart Hospital, which cost $60m to build, cardiologists carry wireless connected laptops, which they use to review patient records, x-rays, or video showing the heart and artery blockages. Technicians remotely monitor patient vital signs from a “war room” near the emergency ward. Two more hospitals will come online this year for remote monitoring, and the room could be expanded to monitor patients with newly im-planted heart devices that can send vital signs information from wherever they are.
Nurses use terminals near the patients to enter data into electronic records. Prescription drugs are bar-coded and scanned to prevent errors. There is no medical records department.
All hospital processes are put through computers. Imaging, medical records, doctors' orders and documentation, drug dosing, vital signs monitoring and nursing notes converge. Mr Veillette concedes the hospital is merely “paper-light” because of documents sent to it, which the hospital scans and discards.
The hospital specialises in heart procedures, such as heart attack emergencies, surgery and catheters inserted into arteries that can deliver stents to prop open closing vessels.
Edward Harlamert, a doctor at the hospital, says that normally a cardiologist would have to cart about a heavy planner book full of appointments and information and try to remember critical treatment decisions while walking between the patient's room, the lab and busy nursing stations. On his handy wireless laptop, Dr Harlamert shows how he can switch from a video recording of inserting a stent into a blocked artery, to e-mail, his appointment book, or the patient record system within seconds. He tries to prescribe 10mg of a blood thinner: the computer warns that he has already given the drug to the patient today, and that the dosage is wrong. Each room has a computer with a screen and keyboard, so Dr Harlamert can show the patient a film of their heart and arteries at the bedside. “For a cardiologist, it's a field so dependent on images.” As well as better medical care, there are administrative efficiencies, which could help curb rising health costs. PwC estimates that the Indiana Heart Hospital experiences 85 per cent less medication errors; much reduced denials or delays in payment, and 80 per cent less patient “chart management” costs than would normally be expected. Mr Veillette says the average length of hospital stay for all cardiac patients is 3.3 days, compared with the US national average of 4.75. The hospital's systems also improve the ability to monitor costs, doctor's practices and patient health. Each quarter, Mr Veillette shows the physicians a report of their procedures, and the costs, including drugs, supplies, patient time and room time. As for fears of a computer crash, Mr Veillette says there are three back-up systems and, more important, nobody forgets how to be a doctor or nurse.
数字医院告别病历
两年前，在周密规划的美国印第安那心脏病医院投入运行之际，院长戴维?维耶特(David Veillette)十分吃惊地意识到自己有所疏漏。他为这家革命性的全数字医院作了精心策划，唯独忘记了垃圾桶。
于是他冲到家居商场，为这家拥有88个床位、21万平方英尺的医院买齐垃圾桶。
这一疏漏表明他对纸张的轻视。他开创了一家全新的近乎无纸化医院，该医院的运行依靠综合电脑系统。
在印第安那心脏病医院，数字信息网络用于收治病人和保存病历。据普华永道会计师事务所(PWC)的医疗研究报告显示，这家医院已成为首批融合信息网络与医疗技术的“真正的数字医院”之一。该医院也是国家级重要医疗信息技术项目的未来风向标。
在英国，“国民医疗服务”计划斥资62亿英镑创建中央化的全国数字医疗系统。该系统将提供网上病人预约挂号、初诊与急诊医护、精神健康以及社区护理。
在医疗系统分散而私营的美国，乔治?布什总统力求达到一个要求更低的目标。他希望在十年之内让所有美国人都拥有电子病历，这是任何综合数字医疗系统的核心。
维耶特先生表示：“这就是医疗的前景……我们才刚刚开始。”在斥资6000万美元建造的印第安那心脏病医院，心脏病医生们都带着无线联网的笔记本电脑，用来分析病历、X射线图或显示心脏、动脉梗塞的录像资料。技术人员在急诊室附近的“作战指挥室”内远程监控病人的生命体征。今年还会有两家医院实现联网以进行远程监控，作战指挥室的作用也可扩大到监控新植入心脏装置的病人，无论病人在哪里，这些设备都可以发出生命体征信息。
护士使用病人附近的终端把数据输入电子病历。为避免出错，处方药都有条形码，并经过扫描。病历部门再也没有了。
医院所有的流程都得经过电脑。成像、病历、医嘱、文件、剂量、生命体征监控和护理记录实现整合。维耶特先生承认，这家医院只做到“减少用纸”，因为它还是收到纸面文件，必须先扫描再扔掉这些文件。
该医院擅长各种心脏手术，诸如心脏病急诊、外科手术、在动脉中插入导管以撑开行将闭合的血管。
该医院的医生爱德华?哈拉梅特(Edward Harlamert)说，通常一名心脏病医生在病房、实验室和繁忙的护士站之间穿梭时，不得不用手推车推着一本厚重的写满预约信息的日程簿，竭力回忆关键的治疗决定。而哈拉梅特医生用他的无线联网笔记本电脑演示了他如何在几秒钟之内，从一段在堵塞动脉中插入导管的录像片断，切换到电子邮件信箱、预约簿或者病历系统。
他想开一个10毫克血液稀释剂的处方；电脑提醒他当天已经把药给病人了，所以剂量错了。每间房间都有一台带有显示屏和键盘的电脑，所以哈拉梅特医生可以让病人看他们心脏和动脉的影像。“对心脏病医生来说，这个医疗领域非常依赖图像。”不仅医疗改善了，管理的效率也提高了，这有助于抑制医疗成本升高。普华永道估计，印第安那心脏病医院发生的用药错误比一般医院少85%；拒付或延迟付款的情况少很多；病人“图表管理”成本比通常估计的少80%。
维耶特先生说，该医院所有心脏病病人住院的平均时间是3.3天，而美国全国的平均时间是4.75天。医院系统也能提高对成本、医务质量、以及病人健康的监控能力。每个季度，维耶特先生给医生们看一份他们工作流程和成本的报告，里面包括用药、供应、病人治疗时间和病房使用时间。有人担心电脑崩溃，对此维耶特先生说医院拥有三个备用系统，而且更重要的是，并没有人忘记自己应该怎样当好医生或护士。
