Building a Better Delivery System A New Engineering/Health Care Partnership (2005) / Chapter Skim
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Information Technology for Clinical Applications and Microsystems
Information Technology for Clinical Applications and Microsystems
Pages 189-224
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Information Technology for Clinical Applications and Microsystems
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how engineering can help establish data to the adoption of information technology are: high capital standards; and (3) how engineering can help build an infor- acquisition costs for electronic medical records (EMR)
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Tools to assist with distributed authoring of key providers -- could be applied to patient care. technical standards would help accelerate the development In short, twenty-first century clinicians have been prac- of essential technical standards.
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This will require a to address this problem. Physicians now have a decision- system that keeps the information separate and encapsulates support tool that shows them patient data and local and na- it in digital rights technology, so that the patient can always tional guidelines at the time they are making ordering deci- pull the key.
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· certification of products for compliance with standards One of the challenges facing informatics designers is the · incentives need for standard structures for representing biomedical knowledge, data, and patient data. We will also need people Some of the new skills caregivers will require are listed who can certify that products are in compliance with various below: standards.
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. Ensuring a safer medi- events that harm patients is computerized physician order cation system at an organizational level, as well as at the entry (CPOE)
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1998. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors.
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Report by First Con frog Group test standard for computerized physician order entry. Report sulting Group to The Leapfrog Group, December 2001.
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The prob lem is that there are many payers, and all of them want to Although good examples of electronic medical records lower costs for the patients they insure by having providers exist, the industry in general has not yet implemented sys- use information systems that support standards of care. If tems that can routinely provide all of the desired functional- United Health Care promotes one standard for people with ity.
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a master patient index, community health information networks, but as of 1995, with in which local medical record numbers/identifiers for each one or two exceptions, when the grant support diminished, person are mapped to a unique, persistent identifier; and (2) a these models disintegrated because of complex legal, orga- longitudinal patient database (clinical data repository)
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Be- tity of the subject and must transmit data in a way that can be cause these alerts must be generated in real time, the design easily accommodated. As more and more monitoring takes of the data dictionary and the clinical data repository has place in the home, these challenges will become more diffiextremely challenging requirements (Bakken et al., 2000; cult.
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2003. Building a comprehensive clinical information system we believe that the confidentiality of patient information can from components: the approach at Intermountain Health Care.
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Bethesda, Md.: menting antibiotic practice guidelines through computer-assisted deci- American Medical Informatics Association. sion support: clinical and financial outcomes.
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tory agency reporting requirements, and many others. Over time, patient demands, as well as our own adminis At the Mayo Clinic, patient records have a long history of trative and clinical work flow, have required us to increase being well organized, thorough repositories of information.
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. thereby allowing graduated access to the record but not nec For Mayo Clinic to continue to provide high-quality essarily to privileged clinical information.
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1989. Old records never die: medical records at the Mayo Clinic.
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Intensivists also serve as is higher. ICU patients have the highest acuity of all patients the leaders of care teams, coordinating the activities of the in the hospital; their mortality rate exceeds 10 percent, and many different physicians and ancillary staff who contribute their daily costs are four times higher than those of other to the care of ICU patients with complex conditions.
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x-rays and other images, unless a digital x-ray system is In the remainder of this presentation, the eICU solution, a already in place. systematic reorganization of ICU care focused on improving Some have suggested that it would be helpful to provide patient safety and operating efficiency, is described.
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211 Server Voice Monitors Area Data Networking & Bedside Video Rooms Patient Monitoring Voice HIS Patient Monitors Monitor ICU Bedside Video Patient -2 Central Hospital Phone printer Scanner Telephone Connection Server Hot Laser ray- Equipment Station X T1 Application WAN/LAN HIS Nurse's Conferencing Access Application Software Server Room Video HL7 Workstation Gateway Software Database Server Clerical Application Connection Server T1 Server Server Voice Backbone Monitors Area DSS Alerts Data Æ Networking & Bedside Video Rooms Patient Network eICU Monitoring Voice Patient Monitors ICU Monitor Patient Bedside Video -1 Vital -End Central or Time Front Real Signs Relay Hospital Connection Backbone Phone T1 Telephone Workstations Phone printer Frame Scanner Telephone LAN Conferencing Hot Hot T1 Workstation Laser ray Station X Video Clinical architecture. Nurse's Software Conferencing Application Application Software Video Remote-care 1 FIGURE
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The eICU Solution repfor prescribing antibiotics. resents a new paradigm for ICU care that treats the manage The third major application, Smart Alerts, functions as an ment of acutely ill patients as an enterprise-wide priority and early warning system.
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2001. Crossing the Quality Chasm: A New Health System for the 21st errors in the intensive care unit.
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Indeed, a subject. Each tag has a GPS and local wireless device and an variety of monitors currently on the market have limited option for storing data related to the subject.
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The engineering agenda for creating the monitoring device is a lightweight, reliable power supply for the pulse HOME CARE oximeter and wireless transmitter. Patient-centered home telecare and health systems have shown great promise, but little modern engineering is being used to develop them.
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for local wireless transmis BLOOD PRESSURE AND VASCULAR COMPLIANCE sion. Pulse oximeters already on the market could be used if they were adapted for wireless transmission (e.g., the High blood pressure is one of the major risk factors for Minolta PulsoxTM system that can be worn on the hand and heart attacks and heart failure.
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. More recently, an array of external elecWIRELESS TECHNOLOGIES FOR PARALYZED trodes have been used as a brain-computer interface that can PATIENTS translate externally detected brain signals (Figure 6B)
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Available online at: http:// In February 2003, the FCC finally endorsed a new ruling www.cyberkineticsinc.com/braingate.htm. loosening restrictions on unlicensed ultra-wideband radio Friehs, G.M., V.A.
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Figures at a Glance, August 2004. Available online at: http:// Proceedings of the National Academy of Sciences 101(51)
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One of the persiscapital. The Veterans Health Administration (VHA)
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There is a great need for engineers to deterprogram has also been modified for other purposes -- for in- mine how to provide comfortable, durable prostheses that do not stance, to help people in a chair who have problems with cause infection. In implants that have been successful, patients visual perception.
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So the dislike of new systems improving patient safety, for example, is based on a research may be only partly because people resist change. It may also model that looks more like continuous quality improvement be because they know from experience that new systems do (i.e., iterative testing of interventions)
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throughs in terms of improving health care delivery should be There are many opportunities for improving the safety working alongside health care researchers. and quality of health care.
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