YNHH gets wired to better care



At the touch of a button, physicians at Yale-New Haven Hospital will soon be able to view patient records and order medications without ever leaving a patient’s bedside.

The hospital, named one of the “100 Most Wired” by Hospitals and Health Networks magazine, is employing cutting-edge computer technology to improve patient care by making the documentation and dissemination of patient information easier, faster and more reliable, a hospital official said.

“We’ve been classified as one of the ’100 Most Wired’ hospitals in the country for the last four years,” said Mark Andersen, senior vice president and chief information officer at Yale-New Haven Hospital. “We’re trying to stay ahead of the game as far as new technologies and modalities go.”

Personal digital assistants and wireless PCs are increasingly utilized by both doctors and nurses in the hospital, he said. Doctors use PDAs to access patient information and charts, while computers on mobile carts allow nurses to place orders for medication and tests on site.

“We have enabled mobile PCs throughout the hospital — primarily to support ongoing care feeds, whether that’s in the emergency room or in the nursing units,” Andersen said.

Despite their benefits, Andersen said the devices have significant limitations that the hospital hopes to overcome as more advanced models are developed and employees gain greater technological experience.

Andersen said that while doctors find PDAs useful for viewing information, employees have not yet found a simple and reliable way to log patient information on the devices, and doctors are unable to place orders via PDAs.

“We are struggling to make [PDAs] workable for entering data,” he said. “The nurses have found them less useful in some cases because a lot of their work requires data input.”

Wireless PCs also have drawbacks — most notably their short battery life. The mobile computers are often used for eight to 10 hours at a time and must be equipped with an external power supply.

Although computers have eliminated some hospital paperwork, Andersen said documentation will become increasingly digitized, down to doctors’ notes from patients exams.

“We still rely on physician and clinician handwritten notes,” Andersen said. “Our goal is to get rid of that over the next three years.”

Eliminating handwritten notes will require computer-based templates, staff training and an adequate amount of hardware. This new method will not be adopted, however, until administrators can guarantee sufficient computer access, Andersen said.

Yale-New Haven Hospital also uses the Internet to give doctors access to patient records and communicate with other hospitals. Using the MD Link program, doctors can view general patient records and directly access core hospital systems if more specific information is required, Andersen said.

“We have a full browser-based program that enables physicians from their home or from the their office to access clinical information about their patients,” he said. “It has enabled us to get clinical results to physicians — more quickly and more accurately than was done before, when reports were mailed or faxed.”

Utilizing the same technology as MD Link, the hospital’s Wellness Information Network allows area hospitals to share patient information.

“The intention of the Wellness Information Network is to ensure that we get patients in front of primary care providers and take care of primary care needs,” Andersen said.

Many local community residents who visit multiple hospitals and clinics and do not get adequate primary care unnecessarily end up in the emergency room, he said. The network not only assures that patients get more complete care at the hospital, but also helps avoid costly emergency room visits.

Administrators at the hospital have both short- and long-term goals concerning the implementation of new technologies in the hospital.

An image scanning system in the emergency department expected to be ready for use this spring will scan paper templates and make emergency visit notes available for doctors online.

“[Because] the workflow is rather frantic at times, this will greatly improve our ability to document what’s going on in the emergency room,” Andersen said.

Speech-recognition technology, although currently unavailable for broad-scale healthcare, is on the hospital’s long-term agenda.

While the hospital is implementing new technologies as they become available, other members of the New Haven medical community are in the process of developing devices that may soon revolutionize patient care.

Researchers at the Yale School of Nursing are studying the use of PDAs to support family management of children’s diabetes. They are testing the feasibility of providing children with small, handheld computers in which to record blood glucose levels throughout the day. The children or their parents can then link the PDA to their desktop to store information.

The children are rewarded for entering their test results with access to PDA games, and researchers are testing the effectiveness of this incentive, said Margaret Grey, associate dean for scholarly affairs at the nursing school.

“If a kid enters a certain number of tests everyday, he or she gets access to a game,” she said.

The new technology may be able to provide parents and physicians with timely feedback concerning children’s blood glucose levels and could soon be available to the general public for use.

Yale Center of Excellence in Chronic Illness Care Director Ruth McCorkle, along with Michigan State University, is studying the benefits of a fully automated telephone monitoring system designed to complement personal care and improve symptom management in cancer patients undergoing chemotherapy.

Participants in the study receive eight weekly telephone calls to assess the severity of seven prevalent symptoms, and physicians can be notified if a patient’s status begins to decline.

“[The system] allows [physicians] to figure out which symptoms they want to monitor and to do so frequently — during after-hours such as evenings and weekends,” McCorkle said.

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