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For other articles and previous issues click here. May 16, 2005 Digital
Hospital PACS and electronic medical records are just part of the new Memorial Hospital Miramar. Upon entering the doors of Florida’s newly opened Memorial Hospital Miramar, patients step into the hospital of the future—a facility that is computerized, robotic, digitized, and wireless. Of course, the human touch remains in the form of the nurses and doctors who administer care. Miramar, the nation’s newest digital hospital, showcases sophisticated technology that has the potential to improve care from admission to discharge. With advanced digital and wireless technology, Memorial Hospital Miramar features a near-paperless environment, with electronic health records (EHRs), facilitywide electronic patient tracking, wireless barcode medication charting, the use of an enterprisewide PACS for distributing digital images across the hospital, and many other innovations. Going Digital Mark Schwimmer, MD, chief of radiology at Memorial Health System, said the system is approximately 99% filmless, except for mammography. Digital mammography is just being introduced at Memorial. President Bush has announced the goal of establishing a network of interconnected regional EHRs within 10 years. The office of the National Coordinator of Health Information Technology, led by David Brailer, MD, PhD, is spearheading the administration’s efforts to increase the prevalence of image-enabled EHRs and healthcare information technology. Memorial Hospital Miramar healthcare providers will consult EHRs using the IDX Carecast enterprise clinical system’s touch-screen computer monitors at each bed. Nurses will use wireless barcode scanners to confirm that the right patient is receiving the right dose of the right medication at the right time. Nurses and doctors will input vital signs, symptoms, and other essential medical notes via an online, bed-charting system. X-rays, CT scans, and MRI scans will be captured and retrieved in a picture archival communication system, where doctors can view them for diagnosis and treatment, even if they are miles away from the hospital. Miramar uses IDX’s Imagecast PACS and RIS systems, according Mark Schwimmer, MD, director of radiology services at the hospital. The emergency department (ED), as well as the entire facility, will have a computerized patient tracking system, helping to expedite care and the flow of patients. “Memorial Hospital Miramar will have the same medical technology and talent as that found in top-tier medical research facilities, yet it will provide a homelike feeling,” says Hospital Administrator Ken Hetlage. “Memorial Healthcare System’s focus is on patient safety. This hospital will surely be the most wired of the Memorial Healthcare System.” “Carecast is a truly integrated clinical information system—with pharmacy capabilities, ordering functions, and the patient’s medical history all maintained on a single platform. It is well-matched for the fast-paced environment of the emergency department, where Memorial is using the system at all five of its hospitals,” Raymer explains. “Carecast offers subsecond ‘thinkspeed’ response time even with thousands of simultaneous transactions—a feature which is critically important to clinician acceptance of these kinds of systems. Carecast is highly scalable and reliable, with a guarantee of 99.9% uptime. System reliability is especially crucial in a near-paperless hospital, where everything from admission through discharge is based on the electronic medical record.” The facility, which opened March 17 at a cost of roughly $143 million, features a virtually paperless environment. Paperless records, Hetlage explains, address patient safety issues because they reduce the chance of human error, eliminate the chance of lost records, and allow data to be used in multiple areas and locations at once. Transcription is completely outsourced. Coding is done in-house, but employees will soon be able to code remotely from home. Why Paperless? “One of our objectives from day one was to be a paperless system,” he says. “One of those components includes a wireless network that goes through the entire hospital. “In healthcare today, more and more facilities are switching to wireless technology, less paper, and more digitized computer systems,” Hetlage continues. “It allows better access to data and that data can be shared with multiple clinicians in multiple areas. It’s a much more efficient record-keeping system.” “The people we worked with at Memorial continually expressed their commitment to patient safety as the reason for embarking on this healthcare IT [information technology] project,” Raymer says. “Carecast’s advanced patient safety features, clinician-friendly screens and workflow, ease of implementation, and reliability all support Memorial’s initiatives to deliver high-quality care in a completely digital environment.” What’s in It for the Patient? Charts will be thinner but that will likely not be a change most patients will notice. The best part of the new technology, Hetlage explains, is that it will be invisible to the patients. “Patients will still get hands-on physical exams and will likely spend more time with the physician,” he says. In addition, having immediate access to a patient’s complete health record—including lists of a patient’s prescriptions and allergies—can help prevent medical errors, improve patient safety, and avoid duplicate tests and other procedures. The system can deliver alerts that warn physicians about drug interactions or suggest best practices for a patient with a specific condition. In 2006, Memorial Hospital Miramar plans to implement the IDX computerized physician order entry (CPOE) solution so physicians will directly enter prescriptions and orders for lab tests and other procedures directly into the Carecast system. CPOE has been shown to improve the quality of care by preventing potential medication errors and significantly shortening the interval of time between when an order is entered and when medication is administered. Compliance Issues? “Some of the things that get faxed, like pre-op orders, will still be on paper, as will patient consent forms,” he says. “Most of the papers that are automated will be hospital staff documentation, ancillary tests, and order results.” As for being JCAHO-compliant, Miramar’s computers will maintain the records that would otherwise be on paper and if a JCAHO surveyor needs access to a paper copy, it can be quickly and easily accessed. Patients will still receive copies of HIPAA privacy policies and have them made part of their charts. “Because of HIPAA privacy issues, some of the hospital’s technology and computer access will require biometric identification in order to access data,” Hetlage says, adding that all computers will be password-protected. About the Facility Other unique features include three isolation rooms for hazardous materials and a bathroom with separate water tanks and air ducts. It offers private rooms along with an array of medical and surgical services ranging from allergy to maternity, pediatrics, bariatric/weight-loss surgery, and urology. An adult ED and a separate children’s ED (affiliated with Joe DiMaggio Children’s Hospital) offers 24-hour emergency care. Miramar houses nearly 100 physicians in its adjacent medical office building. It will also cater to the growing ethnic demographics, providing selected community classes in Spanish. On the nursing end, Miramar opened without any agency nurse staffing and a nurse ratio of 6:1 in medical surgical, 5:1 in telemetry, and 2:1 (sometimes 1:1) in the ICU. — Robbi Hess, a journalist for more than 20 years, is a writer/editor for a weekly newspaper and a monthly business magazine in western New York. |
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