Perspective: One patient's satisfied experience with hospital IT
On Sept. 27, a piece of wood flew up from a power saw, crashing into my thumb. The nail was bleeding and my hand radiated a dull but intense throbbing. I knew that the emergency department made more sense than an urgent care facility, which would not offer orthopedic services.
I live within six miles of 10 emergency departments, but I chose Huntington Memorial Hospital because I knew that this relatively posh suburban hospital might have a better shot at giving me efficient care than other more urban emergency rooms near me. Its good reputation made me choose it over other emergency departments even nearer to my home and equally suburban.
What I did not know is that Huntington had just completed an $80 million donor-sponsored, state-of-the-art emergency department upgrade in 2014.
Located in Pasadena, Calif., Huntington competes for money and patients in population-rich Los Angeles County. It is the only Trauma II-capable emergency department in the San Gabriel Valley. The 626-bed regional hospital often wins awards but has historically struggled with waits in its emergency department. In its recent ED renovation, patient satisfaction was a core consideration of re-engineered workflows and facility design.
According to Tiffany Lemmen, the hospital's director of IT applications and informatics, Huntington Memorial Hospital has 50 ED beds and services more than 60,000 emergency encounters per year, with a capacity of 90,000.
I experienced an efficient system where technology played a significant but almost invisible role in my care. About three hours after entering the ED, I left with a diagnosis of multiple fractures, a splint on my left thumb, prescriptions, educational materials about thumb injuries, and a referral to an orthopedic group affiliated with the hospital.
In a distracted world where computers are often seen as interfering with a clinician's ability to compassionately interact with patients, I delighted at the amount of hands-on direct care I received. The computer in my ED bedroom was never even powered up.
From the moment I walked in, the systems were working hard collecting information, facilitating clinical workflow, and even making suggestions about treatment options and coding basics with a sophisticated recommendation engine built into the hospital's Cerner electronic health record.
When I presented myself at the front desk, even before I saw a triage nurse, the two people on duty – one of whom was a licensed nurse – entered a preliminary ICD-9 code presenting my complaint into the system. (As of Oct. 4, it would have been an ICD-10 code, and from all accounts the hospital has made this transition without any mishaps.) Immediately on an electronic board, visible only to ED staff, my name, my preliminary diagnosis, and other high-level information about me appeared.
At the desk I was handed a clipboard with pages of forms collecting my medical history. As I was filling out that paperwork, a record already had been created for me with a complaining diagnostic code. Mine was probably S69.90XA (unspecified injury of unspecified wrist, hand and finger(s), initial encounter).
I turned paperwork in to the front desk and, unbeknownst to me, almost immediately a physician's assistant would key my paper answers into the system. Lemmen let me know that this is perceived as a gap and that a tablet-based solution for gathering medical history will be rolled out in 2016, after extensive testing and integration.
The team decided on my diagnosis and treatment plan in the "bullpen," a part of a contemporary ED where the doctors sit and other health workers visit. The doctors look at the computerized charts and medical images, and collaborate with one another, sometimes using technology and sometimes with face-to-face conversations.
Had I been a trauma patient, as per the criteria set down by Los Angeles County, I would have been ushered to one of the trauma wings to receive a higher level of care. Instead, I was next seen by a triage nurse. She sent me right back to one of the 50 beds, and a more refined set of notes was entered into the system.
Soon I was seen by a nurse and then a physician's assistant. The PA examined my hand and, upon returning to the bullpen, wrote orders so that I would receive a morphine shot, a disinfecting bath, and an X-ray. Clinical notes were probably also entered into my chart. As I received the treatments and tests ordered, other things were taking place: A doctor actively consulted with the PA and reviewed the orders and, when it was ready, read the X-ray.
The X-ray of my hand was instantly available to the team. The digital image had been beamed from the Philips portable battery-powered X-ray machine to a picture archiving and communication system, or PACS, via secure Wi-Fi. While in my case a doctor at the hospital read it, this is not always the case. Huntington Hospital does not have a radiologist present to read X-rays on Sunday mornings.
If the doctor had wanted a deeper read, it would have been read remotely by a teleradiology service. This teleradiology service is one of the more significant integrations that took place when the Cerner radiology solution was integrated with a PAC and the teleradiology partner. The price tag for this integration was $2 million, Lemmen said.
All along the way the human touch was evident and a powerful salve. The computer systems making the workflows efficient and the diagnostic path simpler allowed for more human touch from the care team.
As I was being discharged, I received ineffective educational material about thumb injuries. Improvement is badly needed here. The educational material I got was neither specific to a thumb or finger fracture nor tailored to my level of sophistication. It was too generic. But my overall experience was one of engagement and efficiency.