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2/18/2004
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Clinical Transformations

Technology alone won't fix inadequate processes. It's critical to design processes to improve patient safety

During the next five years, adoption of IT in the health-care sector is likely to continue at a rapid pace, particularly in the area of integrated clinical systems. Computerized physician order entry, mobile messaging, bar coding, pharmacy systems linked with electronic-medication-administration records, and radio-frequency identification are the technologies likely to experience the greatest focus.

Computerized physician order entry, which has generated the most attention, offers the possibility of reducing the potential for adverse drug events. If used correctly, it can improve patient safety by alerting prescribers to potential drug interactions, allergic reactions, and dosage concerns. Still, areas of the technology need improvement, such as user interfaces and messaging capabilities. In the future, we expect vendors will continue to improve the look, feel, and capability of computerized physician order entry to support safer, more-efficient care, as well as offer better functionality for specialty areas such as emergency medicine, surgery, and oncology.

Mobile messaging also will be a critical part of tomorrow's safety net. Most clinical systems incorrectly assume that all caregivers who need patient information are always on hospital premises. Messaging systems must get the right information in the right way to the right people in a timely manner, regardless of their location. To alleviate this problem, vendors are improving how systems can push and pull information to and from caregivers, who could be located in a variety of places, using an array of devices.

Interestingly, bar coding, an older technology, is generating renewed interest in the area of patient safety. Most vendors of advanced clinical systems don't have a deployable bar-code system that encompasses medications, supplies, blood products, and lab results. But development is occurring rapidly in this area, and it's likely that advanced clinical systems employing comprehensive bar-code solutions will replace standalone systems over the next few years.

While pharmacy systems have been around for more than two decades, systems that can do all things well can be counted on one hand. Like computerized physician order-entry systems, pharmacy systems are critical to support medication safety. To be most effective, they should be viewed as a key part of the overall clinical system and not treated as a standalone ancillary system. Reflecting pressure from the provider side, we're beginning to see improvements in the pharmacy offerings of several vendors of advanced clinical systems, but some would still be best described as "in development."

The same is true of electronic-medication-administration records. These systems again tie critical information from within an advanced clinical system to the point of care and should be closely linked with other aspects of clinical documentation. Like computerized physician order entry, the user interfaces and screen flows of some of these systems need to be improved before they can be effectively used by those involved in the more-complex areas of care such as oncology, critical care, or emergency medicine. At present, many electronic-medication-administration records systems are at an early stage of development.

Finally, RFID, a technology that's getting a great deal of attention for supply-chain management in the retail and defense sectors, could have potential application in health care for tracking medications, supplies, and medical devices. Though promising, this technology is unlikely to see widespread use in health care in the immediate future.

One final note: While new and emerging technologies have encouraged organizations to select and implement advanced clinical systems, we mustn't expect these technologies alone to transform care. It's equally critical to design new processes to improve patient safety. The truth is, technology alone won't fix inadequate processes, and we must be vigilant about improving underlying patient safety processes to achieve sustainable improvements and truly transform how we deliver care.

Brian F. Shea, Pharm.D., FCCP, BCPS, is a senior manager in Cap Gemini Ernst & Young U.S. LLC's health-care practice. He can be reached at [email protected].

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