Dr. James J. Cimino had a problem. To find out if his patient's confusion was a sign of neurological disease, Cimino needed to test the man's spinal fluid. But scheduling a visit to Columbia Presbyterian Hospital's busy neurology unit was difficult. So he made a note in his computer: Order a spinal tap the next time the patient's chronic heart condition brought him to the New York City hospital's emergency room. Two weeks later, the patient was there. And yes, having read Cimino's note--which was stored with the patient's records in the hospital's computer system--doctors did the spinal tap.

The case exemplifies how reengineering hospitals with sophisticated computer networks can help cure one of medicine's worst ills--inefficiency. "Up to 40% of all hospital costs are related to the generation and storage of information, so it makes sense that information technology can improve efficiency," says Dr. William M. Tierney of Wishard Memorial Hospital in Indianapolis.

Wishard now requires doctors to order all drugs and treatments for patients via computer. The system then automatically warns of potential problems, such as allergic reactions or duplicated tests. Doctors tend to make fewer mistakes and order fewer tests. The result: Costs per patient are $900 less. "To stay competitive," concludes Tierney, "doctors really have to get into the electronic medium."

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