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Mission: Critical

Imagine 30% fewer deaths in intensive-care units and half the medication errors in hospitals. IT is poised to deliver improved patient care.

If drugmakers put bar codes on single-unit medicines, it would make it cheaper and easier for hospitals to deploy computer drug systems that use bar codes. Some medical-supply and drug distributors such as McKesson Corp., as well as IT-services firms such as EDS, can help build bar-code systems, including those for use at the patient bedside, and robotic systems to improve efficiency at hospital pharmacies.

The Institute of Medicine estimates 770,000 adverse drug events a year lead to injury or death in U.S. hospitals. It estimates 28% to as many as 95% result from preventable errors. It was this 1999 research that prompted the FDA to investigate ways of reducing errors.




After electronic-monitoring systems are in place at its hospitals, Sutter expects to significantly improve intensive care.
Only about 300 of the nation's 6,600 hospitals have bar-code drug systems, of which about 130 are Department of Veterans Affairs facilities, estimates Jeff Schou, director of worldwide health-care markets at Symbol Technologies Inc., a maker of bar-code devices. The success of the VA's bar-code drug system was a big factor in the FDA's deciding that such systems could deliver major reductions in medication mistakes.

The FDA rule would mandate only that drug companies add the bar codes within three years. It would not force hospitals to deploy computerized systems. But that's the FDA's goal. Hospitals have been reluctant to invest in the systems because many single-dose drugs don't come with bar codes, and drugmakers have been reluctant to use bar codes until there's demand. Once drug companies are mandated to include the single-dose bar codes, "the hope is it will get hospitals to deploy the systems," says Jerry Phillips, associate director of the FDA's office of drug safety.

The FDA estimates the bar-code rule would cut in half the number of medication errors at the point of dispensing drugs, translating to more than 400,000 fewer adverse events per year--and savings of more than $41 billion over the next 20 years because of shorter hospital stays.

Some health-care companies already have computerized order-entry systems that replace handwritten prescriptions with electronic orders, eliminating errors caused by doctors' messy handwriting. Most of those systems check patients' electronic medical records and red-flag possible allergies and suggest alternative treatments. CareGroup Healthcare System, a network of Boston hospitals and doctors, has cut drug-related errors at least in half in the two years since it deployed electronic prescriptions. However, CareGroup hasn't yet deployed a bar-code system for use when medications are dispensed to patients. When that happens, "that will close another big loop" where mistakes occur, CareGroup CIO John Halamka says.

A bar-coded drug system could greatly reduce one category of mistakes, but there are other, broader IT developments aimed at improving care by providing more real-time information with which to make decisions and to make time-pressed nurses and doctors more efficient.

One is converting more information into digital format for delivery through portals to Internet-connected devices. Digitization is making the rounds at hospitals, starting in labs and X-ray and imaging centers, where information that needs to be shared widely is generated. "What drives our technology strategy is getting more information into the hands of clinicians so they can make better clinical decisions and act on the most timely information," says Steven Stanic, CIO of Memorial Health University Medical Center in Georgia.

In what's becoming an increasingly common platform, Memorial's doctors can access a physician portal for patient medicine, health records, and lab results. A Web-based order-entry system also lets doctors order tests and drugs from their offices or via tablet PCs at the hospital. As more information becomes available digitally, the value of accessing it wirelessly grows. And once wireless networks are in place in hospitals, they may have even broader uses, such as tracking equipment and patients using radio-frequency ID tags.




Only about 300 of the United States' 6,600 hospitals have bar-code drug systems that prevent mistakes from happening.
The savings in terms of financial costs and lives are stacked in favor of these technologies. In addition to a 25% drop in mortality rates, the Cap Gemini Ernst & Young study of two Sentara Health eICU units in Norfolk found that people had a 17% shorter stay in ICUs, letting the units treat 20% more patients. The study calculated a $3 million-a-year net gain for the 16 ICU beds. Sutter's Hummel sees possible business opportunities in providing remote ICU services to non-Sutter hospitals in rural areas that have difficulty recruiting ICU physicians.

But are patients--and doctors and nurses--ready for this kind of technology-enabled delivery of health care? Patients might need to give up the idea that a doctor is physically down the hall. Doctors and nurses will have to overcome the idea that bar-code and other alert systems question their competence. And they'll have to decide if checking vital signs on computers and remote cameras still feels like practicing medicine.

Yet this brave new world is nothing close to automating the practice of medicine. Software is still somewhat dumb--all it can do is recognize changes and trends in vital signs and send up alerts. "For every 50 to 100 alerts, maybe one is important," Sutter Health's Ikeda says. "It's my job to investigate if vital signs are changing because the patient is eating his breakfast or because something more serious is happening."

Mary Beth Navarra is a former practicing registered nurse who, as director of automation planning at McKesson, has brought technologies such as bar-code drug-readers into hospitals. She's seen the resentment when they're first installed. "But the minute a nurse sees the system catch an error before she's about to administer a drug, she never wants to go back to not having that extra level of security," Navarra says. Given the chance, patients will almost certainly feel the same way.

Photographs by Angela Wyant

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