Doc-database link drives clinical systems

By John Andrews
12:00 AM

When it comes to mobile clinical and knowledge management systems, vendors and users say the true value is in retrieving reliable information quickly - whether from the patient's chart or from an online medical library. At this point, the process of using hand-held PDAs to access Web-based data repositories is still in its infancy, but it has the potential to wean physicians, nurses, pharmacists and other clinicians off their paper dependency for good while simultaneously upgrading patient care quality, system manufacturers contend.

Alan Ying, CEO of Durham, NC-based MercuryMD waxes enthusiastically about how the combination of speed and simplicity has catapulted the company's MData Enterprise System into 120 hospitals in just two years.

"We've hit a nerve," he said. "There are a lot of systems out there, but they're not being used because the information is hard to retrieve," he said. "The only way to make data useful is to get people to want to use it."

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To illustrate his point, Ying likened the current state of electronic data retrieval to reading a dictionary.

"You don't read the dictionary as a book, you only use it as a reference tool to look up words," he said. "Right now you have to read data systems as a dictionary and no one is willing to page through it. What we've done is present the user with a reason to look up words."

The MercuryMD system allows users to look up clinical content in any one of several online data repositories from the patient's bedside. System logistics direct physician inquiries about a patient's incongruent symptoms, potential drug interactions or any other clinical anomaly to the proper online source. Because it is all done at the point of care, it eliminates chasing paper and standing in line at computer terminals, said Dennis DeMasie, chief information officer at St. Mary's Medical Center in Evansville, Ind.

"We've been moving toward the electronic health record and putting documentation online, so we needed a tool that makes those results available to physicians right away as opposed to a nurse writing it down on paper and transferring it later," DeMasie said. "The MercuryMD solution gives them everything we've electronically captured so they can stand at the bedside and look at the blood tests, medications, transcribed reports, medical histories and other physicians' notes on the palm top. It improves their practice of medicine and allows them to make quicker decisions at the bedside."

Although still in the pilot stage, Burlington, Vt.-based IDX is working with eMedicine.com on what they hope will be a system that gives physicians the most comprehensive source of online clinical reference materials. Using a process designers are calling "contextual content linking," physicians are expected to have context-sensitive access to eMedicine's Clinical Knowledge Base - including peer reviewed articles on more than 6,500 diseases and conditions at the point of care.

"What we've focused on is the advancement of fail-safe care - the right information at the right time for the right people with a single click," said Graham Hughes MD, director of research and development for IDX Carecast. "The answer to a physician's question about pediatric asthma is two minutes away."

Newton, Mass.-based eMedicine hosts the virtual medical library, which contains detailed information about all 62 medical specialties. Chairman Deryk Van Brunt said the challenge from the outset has been to give physicians the most accurate, credible and comprehensive medical information possible.

eMedicine's contributors (more than 10,000 physicians) have built a vast database that features 10 advisory sections, including clinical review, differentials, diagnosis questions, lab workup, plan of care, medications, follow-up and monitoring, medical/legal considerations and continuing education.

"We're giving physicians specific guidelines for specific treatments," Van Brunt said. "The quality of the content is critical. All articles have five levels of peer review, which is as stringent as the most stringent medical journals. It has to pass a gauntlet of review from four physicians and one pharmD. Then and only then does it get published."

As an ophthalmologist, Sam Bierstock, MD, understands the tremendous amount of data physicians need regarding patient health records and the obstacles they have traditionally faced in getting it. As vice president of medical affairs for Boca Raton, Fla.-based Eclipsys, Bierstock says physicians will appreciate how using electronic order entry brings the data to them instead of having to go to the data.

"Doctors have access to any information that once required them to travel all over to find," he said. "Now you can get everything - all the patient's medical history data and all the patient's records, including lab tests from every encounter. In the past it would have meant making a trip to the medical records department, and - assuming it was there - pulling it, going through volumes of paper and hoping the data you're looking for is in it. That can add up to several hours a day."

Alamance Regional Medical Center in Burlington, N.C, has measured its productivity gains since implementing the Eclipsys physician order entry system in 2000 and the results are impressive, said Ken Fath, MD, cardiologist and medical director of performance improvement and medical informatics.

Approximately 80 percent of Alamance's physicians use the Eclipsys system and an internal study found that potential errors were reduced by 72 percent, duplicate lab orders decreased 58 percent and medication order processing cycle times went from 86 minutes to three minutes.

The electronic format has dramatically increased nurse satisfaction as well.

"We don't have any definitive data to show it, but when you consider that the physician order entry system has virtually eliminated the need for nurses to decipher our handwriting on orders, it's pretty obvious," he said.

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