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The chief consumers of patient information--physicians--are often the last to actually use systems that are designed to provide that information quickly. The reasons for this are deeply entrenched, but if physicians are properly incentivized and adequately trained, they can leap this hurdle. Competitive advantage to hospitals is an immediate benefit, as well.
By combining a unique 'sales' approach with a system truly designed to meet users' needs, a Denver physician and medical affairs vice president is convincing healthcare providers that computers are not the way of the future, but of today. During an on-site visit with Computers in Healthcare Editor Carolyn Dunbar and Michael L. Laughlin, industry editor, Patrick Roney, M.D., explained how Denver's Swedish Medical Center is plunging into the Computer Age.
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Patient care efficiencies and quality of care improvements require progressive efforts to integrate the patient information systems and allow for on-demand accessibility to authorized information users. The dilemma facing the designers and managers of these systems is that each step toward improving accessibility seems to introduce another potential information leakage point. We are reminded once again that information is a very difficult resource to control because it is possible to steal it without removing it physically from its storage place. The essence of information security in physician links is captured by establishing mechanisms for identifying system users, limiting user authority, assuring the privacy of transmitted data, and monitoring system use and users.
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The Providence experience provides a model which encompasses both preparation for a computer-based patient record and a physician-oriented approach to achieving quality documentation for the physician component of the patient record. The study comparing Providence to a similar medical center demonstrated the value of the new system in achieving quality patient records. Many hospitals in the Seattle area, including Overlake, now use this system or variations of it.
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This article introduces the concept of a utilization care plan (UCP) for supporting the communication of data required for effective utilization review and utilization management. Utilization review is a process of measurement that compares the performance of a ward, department, or entire facility against accepted criteria to identify resource use shortfalls. Utilization management is the deliberate action by third party payers to ensure that shortfalls in resource utilization are minimized. Critical to the success of utilization management is effective data communication; utilization review data must be accurate, complete, accessible, timely, and coordinated. Computer-based UCP systems can remind caregivers when and what services should be provided to patients and also monitor the portion of those services that should be administered during each phase of a patient's therapy. Deviations from the UCP system template constitute variances that can be documented and highlighted in a friendly automated system that ensures highly accurate and extremely timely concurrent utilization information. Some implications of using UCP systems for future research and practice are also discussed.
Computer-based patient records (CPRs) have been under development for more than a quarter of a century. In comparison to the traditional paper medical record, they offer a vast improvement in reporting, organizing, and locating clinical information; they can support clinical decision making; and they can be designed to coordinate and manage patient care. Research concerning these three functions is reviewed. Despite their demonstrated benefits, CPRs have met with limited acceptance among physicians. Barriers to their acceptance and ability to change practice behavior are discussed. Empirical studies that have used opinion leaders among physicians to encourage the use of a medical information system and to change practice behavior are reviewed. Finally, suggestions as to how to facilitate the development and adoption of CPRs are outlined.
Physician data entry and use of clinical workstations is one barrier to computer-based patient records (CPRs). Often, clinicians do not understand the potential benefits of CPRs. For the benefits to be realized, however, clinical personnel must use the workstations for both data entry and retrieval. The article reviews recent experience with physicians' direct data entry. It summarizes benefits that clinicians have realized from such systems and also disincentives to their use. It concludes by discussing implementation strategies for enhancing the benefits and reducing the barriers.
A literature review of articles describing the development and implementation of automated medication administration records is summarized, and the results of a survey undertaken of all hospitals in Missouri to determine the extent of an automated medication administration record (MAR) are reported. For hospitals with an automated MAR, the survey compiled information about the demographics of responding facilities and production and distribution, design, implementation, and procedures for use of automated MARs. The most frequently reported advantages of an automated MAR were a more legible document, increased accuracy, savings in nursing personnel time, and fewer medication errors. The most frequently reported disadvantages were increases in pharmacy personnel time, different interpretation of orders by pharmacy and nursing, and multiple entries required for a medication order to appear correctly on the MAR.