Point-of-Care IT: Improving Patient Care
Patient care is receiving unprecedented scrutiny from the public because of increased awareness spurred by recent studies. Pressure from the federal government, media, and consumers is pushing health care facilities to recognize electronic systems, such as electronic medical records (EMR) and computerized physician order entry (CPOE), as a necessary means of improving patient care and reducing costs.
As transitions are made toward these more effective approaches in treating and caring for patients, the role of data collection, transfer, and interpretation becomes vital in how the transitions are implemented. The new EMR systems alone are not sufficient to support a total improvement in the quality of care; they must be augmented by point-of-care IT. Point-of-care IT enables the maximization of potential benefits of EMR and CPOE systems.
A broad range of benefits from using point-of-care IT devices includes error reduction, streamlined workflow, alleviated nursing shortage, cost reduction, and an overall improved standard of patient care. These benefits affect virtually every aspect of the hospital environment. Patients are confident in the quality of care they receive, because the opportunity for errors is reduced. Clinicians are happier and more efficient because their workflow is streamlined. Hospital executives are secure in the lowered costs resulting from shorter stays, fewer lawsuits, and less administrative expenses.
The Need for Point-of-Care IT
Findings from the Medication Safety Self-Assessment conducted by the Institute for Safe Medication Practices (ISMP) strongly support the need for point-of-care IT. For example, the ISMP discovered that only 43 percent of responding hospitals can easily access essential patient information and only 53 percent can easily access drug information. All clinicians must have immediate access to this critical data 100 percent of the time.
Point-of-care technologies have received support from several government officials, including President Bush, and Senators Edward Kennedy and Hillary Clinton. President Bush recently spoke of the need for more IT in health care to reduce medical errors. He encouraged using information technologies to avoid dangerous medical mistakes in his annual State of the Union address.
Throughout the past several years, numerous point-of-care information technologies have been developed for use in health care, such as bar code scanning, automated vital signs charting, mobile computing, and bedside medication administration. These technologies address the most pressing issues facing the industry.
Error Reduction
Because of medical errors, the United States Department of Health and Human Services estimates approximately $37.6 billion is spent annually. Medical errors lengthen hospital stays and cost billions in lawsuits and emergency treatments. Handwriting discrepancies and transcription problems contribute to a large percentage of these medical errors. In fact, some studies estimate as many as 10 percent of all handwritten prescriptions are illegible. Because physicians hurriedly perform the necessary paperwork in order to move on to the next patient, oftentimes their writing is sloppy and includes abbreviations. A nurse or pharmacist may later err in trying to decode the sloppy handwriting or confusing abbreviations. Cases have been documented where pharmacists misread prescriptions and gave patients wrong medications that contributed to the patients deaths.
But handwriting discrepancies are not exclusively problematic of physicians. Nurses often jot notes that can end up lost, or they write down important data for later transcription. If a clinician has to transcribe information into the hospital information system (HIS), there still remains a possibility for error. These problems lead to errors such as mistakes during operation, medication overdose, wrong medication delivery, and more.
The ability to immediately access and update this data through computing at the point of care reduces the risks associated with transcription mistakes and handwriting discrepancies.
Streamlined Workflow
A recent survey conducted by MercuryMD, Inc. concluded that health care residents in the United States spend more than 38 percent of their time at work managing data, but only 16 percent in direct patient care. This survey indicates that, at a minimal 30-minute-per-day data management estimate, bedside electronic data entry reduces residents workload by three hours per week. In a facility with 100 residents, this saves about 300 hours per week, or as much as 15,600 hours per year. These saved hours result in enhanced patient care because more time is allotted for direct patient interaction.
Many nurses also spend a majority of their time in data management activities such as filing patient records, updating paper charts, and transcribing patient data into the computer system. Point-of-care computing eliminates transcription time and streamlines workflow, therefore allowing more time for patient interaction. When mobile computing is integrated with bar code scanning, medication delivery, and automated vital signs charting, valuable time is maximized.
Studies have shown that during the next 20 years the demand for clinicians will continue to rise. Although the supply of clinicians will gradually increase, it will not meet the demand of the growing population. In addition, another problem facing the health industry is the aging of the baby boomers, many of whom by the very nature of aging will require increased medical attention. Point-of-care IT allows nurses to perform twice the amount of work in half the time. Through these better efficiencies at the point of care, the impact of the national nursing shortage can be minimized.
Cost Savings
The ever-rising expenses within the health care industry make cost savings extremely important. The Department of Health and Human Services currently attributes health care costs to 15 percent of the nations gross domestic product, and expects that figure to climb.
Point-of-care IT has demonstrated proven cost savings. For example, recently Senator Edward Kennedy requested the United States General Accounting Office (GAO) conduct a study and submit a report highlighting the benefits of IT in health care. In this study, data from 10 health care organizations was analyzed to determine measurable results from implementing clinical IT. A 927-bed teaching hospital that implemented point-of-care IT saved more than $1 million annually in transcription costs, and $5 million in drug costs through point-ofcare computerized prompts that suggest alternatives to save money and increase quality. Another teaching hospital reported $8.6 million annual savings from eliminating paper records. The overall average annual savings of implementing IT was a 50 percent decrease in transcription costs and error reduction. Computing at the point of care results in cost savings from reduced lawsuits, reduced paperwork (and storage space), and reduced administrative work hours.
Point-of-Care IT
Point-of-care IT is the solution for improving the quality of patient care. The difference in quality patient care in a typical facility that leverages IT at the point of care and a hospital that is still relying on outdated methods is paramount. For example, in a facility still using paper charts, an average day for a nurse includes hours of attempting to decipher physicians scrawls and manage patients cumbersome paper charts. This process lends itself to creating multiple opportunities for errors, from misinterpreting a handwritten order to misplacing a paper record. In a facility that has established an EMR system, but is not utilizing point-of-care IT, multiple errors can still be made during transcription. These preventable errors result in wrong type of medication, wrong dosage of medication, wrong time of medication delivery, mistakes in the operating room, and even death.
However, in a facility utilizing point-of-care IT, the opportunity for human error is considerably reduced. Nurses can clearly read physicians orders and determine which actions to take. Medication delivery, surgery procedures, and general care are smoother and more accurate. Clinicians are confident in their decisions and patients are confident in the quality of care they are receiving.
Still, many hospitals in the United States have yet to successfully integrate beneficial IT. Current estimates document that between 10 and 20 percent of American hospitals have implemented electronic record systems, and even less have integrated point-of-care IT. The Institute of Medicine released a report in late 2003 that called for improvements in clinical communication and information in health care facilities. The report compares the smooth flow of real-time information within the airline industry to the continually paper-burdened and error-prone health care industry. In this document, the author explains how pilots have instant access to all data needed regarding weather conditions, mechanical functions, navigation, delays, and more to assist them in making informed flight decisions. The author further explains that the IT utilized in the airline industry should be similarly applied to health care to standardize the quality of patient care. This goal can be effectively reached through use of point-of-care IT that:
- Reduces errors;
- Lowers costs;
- Is safe and secure;
- Offers complete and immediate feedback; and
- Is easy to operate.
Mobile Computing
When health care facilities implement an EMR system, it is important to ensure that computers are available when and where the clinicians need them. Immediate computer access at the bedside further improves patient care by allowing patient records to be instantly accessed and updated. Senator Hillary Clinton recently offered a proposal encouraging point-of-care IT to improve health care in the United States. According to Senator Clinton, spending the money to produce electronic information is worthless unless it can be retrieved at the bedside.
Handheld PCs and PDAs are both effective for bedside computing, as is utilizing a mobile computer cart. Many health care facilities have implemented these carts, replacing the traditional stationary nurses station. They are wireless workstations, which can accommodate a laptop, thin client, or tablet PC. The nurse or physician doesnt have to carry and keep up with a handheld device; the tools needed are integrated with the cart. These versatile carts can also integrate bar code scanning systems, automated vital signs monitoring devices, and more. This solution enables nurses to spend more time with the patient, rather than down the hall at the desk inputting information.
Bar Coding/Medication Administration
Bar coding technologies assist busy clinicians in medication delivery by alerting them when they are about to give a patient a wrong medication, at the wrong time or at the wrong dosage. Clinicians scan their identification, the patients identification, and the bar code label on the medication. This process is not only monitored and checked by the technology, but is also uploaded into the electronic medical record, which reduces keystroke errors.
With bar coding technologies, hospital pharmacists are also included in the bedside medication administration process. They have real-time access to patient conditions and how medications are being delivered. This allows pharmacists to make immediate recommendations and prevent delays in such instances as IV pump depletion.
Bar coding technologies save lives, time, and money. One example from the previously referenced GAO study cited a 350-bed rural community hospital using bar coding technologies that had prevented administration of more than 1,200 wrong drugs or dosages and almost 2,000 early or extra doses. These measurable results solidify the success of such bedside IT devices.
Automated Vital Signs Monitoring
When clinicians conduct their rounds in a typical health care facility, checking vital signs blood pressure, temperature, blood/oxygen level (SpO2), and pulse rate they record the data on a handwritten chart. They then move on to the next patient and repeat the same process. If the facility uses electronic medical records, they will later enter all the patient data into the HIS. The opportunity for transcription mistakes and errors is substantial, and performing these tasks in this manner consumes a large amount of valuable time.
However, facilities that have adopted automated vital signs monitoring save time and reduce the possibility for errors. The clinicians collect their patients vital signs, make two mouse clicks, and move on. All the information is electronically captured without involving transcription or handwritten data. The vital signs are instantly entered into the patients electronic medical record and the HIS. Linking data capture to the electronic medical record vastly reduces human error and elevates patient care to a higher standard.
The Complete Solution
Today, the ideal scenario in a health care facility with an implemented EMR system consists of the following:
A nurse enters the patients room pushing a mobile computer cart and collects the patients vital signs using an automatic, electronic vitals monitoring device. With two mouse clicks the vitals are seamlessly entered into the electronic medical record, which is immediately updated with this new data. The nurse uses the bar code scanner that is integrated with the mobile cart and scans ID, the patients ID, and the medication bar code label. The patients electronic medical record is instantly visible in real time on the computer screen. If the green go light flashes, the nurse delivers the medication. If there is an error (wrong dosage, wrong medication, etc.), the computer will audibly and/or visibly alert the nurse of the error. The nurse identifies and corrects the problem. The interaction is electronically documented and the patient information is immediately available to clinicians enterprisewide. This entire process involves no writing, no transcription, and does not rely on human interpretation.
Implementation and utilization of point-of-care IT simultaneously improves patient care while decreasing costs for the U.S. economy. Standardized use of these tools has the potential for a true revolution in current health care practices.
