The MD Meets IT

Hospitals are using the Net to share info, do remote diagnoses, give patients faster access to results -- and cut costs

On a brilliant day in April, Dr. Stephen O'Connor sits in a darkened room in the radiology department on the third floor of Tripler Army Medical Center (TAMC), a flamingo-pink facility near Pearl Harbor on the Hawaiian Island of Oahu. Two large high-definition monitors before him display a milky image of a chest X-ray taken a few minutes earlier at Camp Zama, Japan, located 25 miles south of Tokyo -- and 3,900 miles from TAMC. With a few mouse clicks, O'Connor rotates the image and discerns that the patient has nothing unusual in his thoracic region.

O'Connor types an e-mail to a doctor back at Camp Zama and hits the send button. The general practitioner in Japan receives the note and prepares a treatment regime for bronchitis instead of a more serious illness. The sick soldier finds out quickly what is -- and isn't -- wrong with him. And the military possibly saves several thousand dollars by avoiding a medical evacuation of the soldier back to the U.S.

Like many other American military installations around the Pacific Rim, Camp Zama isn't large enough to merit a full-time radiologist. That's particularly true these days, as military radiologists are in extremely short supply. To address situations like this, in the late 1990s the Defense Dept. authorized TAMC to provision a secure, dedicated communications network with a hub on Oahu connecting Zama, Guam, and other U.S. bases around the Hawaiian Islands and the Pacific.


  That high-speed, high-capacity system is used daily to transmit and receive hefty medical images: Two chest rays can represent 20 megabytes of data. As an added benefit, TAMC stores all medical images, with the exception of mammograms, in an all-digital format. This means images are generally easier to find and consult. "We're talking about a turnaround time on radiological consults anywhere in the Pacific of 30 minutes," says Lieutenant Colonel David Gilbertson, information-technology director at the hospital.

Health care is considered the least efficient sector of the economy

TAMC is in the vanguard of a growing movement to wire American hopsitals in hopes of squeezing more efficiency out of a health-care system that's staggering under steadily shrinking reimbursements from Medicare and health-maintenance organizations (HMOs). Hospitals and physicians have long been considered one of the least efficient segments of the U.S. economy. So with lower HMO and Medicare payments taking a bite out of hospital revenues, many institutions are looking to get wired to become more efficient. That means everything from installing all-digital X-ray imaging systems to tying into electronic health-care exchanges that allow hospitals to further automate transactions with big vendors.

Most of these initiatives involve tapping into the Net one way or another. Now, less than 10% of hospitals around the country use telemedicine networks. Likewise, less than 10% have transformed their X-ray departments to all-digital systems that allow them to store images in bits rather than in file cabinets. And less than 10% use digital medical-charting systems to organize unruly piles of paper.


  That's another area where TAMC is paving the way. It uses a computer network, dubbed the Composite Health Care System (CHCS), that's designed to collect and maintain patient records in a digital format. For more than a decade, doctors at TAMC have typed their medical notes into a text-based database system that stores key patient data such as allergies and most recent course of treatment.

This allows doctors to easily retrieve, share, and browse through their own notes or the notes of other specialists from any computer in the network. This so-called physician order-entry system is touted as a way to reduce medical errors resulting, as often as not, from bad handwriting, says Dr. George Underwood, a pulmonologist and the director of the CHCS effort at TAMC.

Phone calls to suppliers are another drag on efficiency at hospitals, which face a Byzantine network of middlemen often carrying the same products. Centura Health, a Colorado nonprofit that operates nine hospitals and books gross revenues of $1.1 billion annually, has tried to streamline its contacts with suppliers by signing up with Global Health Exchange (GHX) -- a Web consortium of big drugmakers and health-care equipment makers including Johnson & Johnson (JNJ ) and General Electric (GE ), among others, that aims to create a neutral Web marketplace to bring buyers and sellers together.

"The cost [of installing GHX] was pretty much zero"

Sounds dot-com retro? You bet. But Centura CIO Elaine Callas believes GHX has enough industry backing to stick around. And she can't argue with the $600,000 in one-time savings she'll accrue through GHX when it replaces the various proprietary electronic data interchange systems, or EDI, that Centura had previously maintained with suppliers. Callas' troops are working to connect their enterprise-resource planning software from software company Lawson (LWSN ) directly into browser-based GHX systems to give all employees a further ability to see key information on shipping and packages. "The cost [of installing GHX] was pretty much zero," says Callas, who expects to have the full system running by July.


  Cutting-edge hospitals are also turning to the Web in an effort to improve relations with patients. Take M.D. Anderson Cancer Center in Houston. In 1997, the hospital began thinking about Web initiatives to automate paper flows, says Alan Powell, its director of Internet services. It sought out Computer Sciences Corp. (CSC ) for help in installing a content-management system called Spectra made by Allaire (which was subsequently purchased by Macromedia [MACR ]).

Since then, M.D. Anderson has added a variety of interactive capabilities. Now, after logging onto the hospital's Web site, patients can send secure e-mail to their physician. This replaces e-mail over the public Net, a security risk, or calling doctors and interrupting their work. The hospital also will e-mail patients when test results are ready. Patients can then log onto a secure Web site and view the results from almost any computer.

"Patients are obviously pretty anxious to get results. Sometimes we end up playing phone tag with them for days. But we can put that out through the Web site, if they are agreeable to that. This makes it much easier for them to retrieve the information," says Powell.


  Making bills easier to deal with is another key reform hospitals are pursuing. The Childrens' Hospital of Pennsylvania (CHOP) also used CSC for help with its Web site, which now includes a color-coded billing system. When patients get their bill in the mail, they can go to the Web site and click on a department that has the same color as the bill. That allows patients who have a question to direct queries about bills to the right department, explains Evan Crawford, director of Internet initiatives for CHOP. It also avoids time-consuming phone calls.

Another critical area that hospitals are keen to explore is wireless Web access. Physicians move around a lot during their work day. So personal digital assistants present an ideal solution for doctors who want to enter information into a patient's file without going back to their office to do it.

Anderson has a pilot project that allows physicians to connect wirelessly using customized Palm handhelds. And Centura has wireless Web access in the emergency room to allow nurses to quickly find a patient's insurance records -- and physicians to look at medical records after hours, when the hospital's records department is closed. That's one of the big benefits of the wired hospital -- vital info available whenever it's needed.

By Alex Salkever

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