Rudy Herndon, chief information officer of Valley Health System, shows off the company's central computer center.

Quicker Than You Can
Say "Stat!"
Virginia's hospitals are gaining national recognition for using information technology to improve health care.

By KATHRYN N. DAVIS

When the nurse enters your hospital room at Winchester Medical Center to do your admission assessment, she will bring a "buddy" with her. But don't worry, she's not trying to turn your medical malady into a public spectacle — her companion is a computer.

"We have laptop computers that we fondly named 'nurse buddies,'" explains Gena Swisher, director of patient services at Valley Health System, the parent company of Winchester Medical Center. The laptops are wireless, and they connect to the main information system via radio waves, similar to the way a cell phone works. The admitting nurse enters her findings directly into the database while she's in your room, and the results are immediately available online to other clinical departments.

The health care industry may have been slow to enter the information age, but it is jumping in with both feet now. And several Virginia hospitals are making a big splash nationally. In February, Hospitals & Health Networks magazine ranked Valley Health System, Sentara Healthcare, and the University of Virginia Hospital among the 100 most wired health systems in the country.

"We're working very hard to bring value and improve quality," says Rudy Herndon, vice president and chief information officer of Valley Health System.

"We have some key prompts that, based on information given on admission, generate referrals to other departments," Swisher says. For example, if the nurse finds out that the patient has been vomiting for three days before coming to the hospital, she enters the patient in the system as having a nutritional risk. Automatically, a consultation request prints out in the dietary department. It's not as dramatic as ER doctors running around shouting "Stat!" But it's much quicker.

"Roving admitters" at Winchester Medical Center function much like the "nurse buddies." Instead of stopping at the admitting department to fill out paperwork, patients go straight to their rooms, and the admitting department comes to them. In the emergency department, patients don't have to sit at a registration desk answering questions. The information is gathered while the patient is in the treatment room.

"We use technology to pull our regional hospitals closer together," says Herndon. All Valley Health System facilities are connected to a central computer center on the parent company's campus in Winchester, and they use common software to communicate easily.

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Columbia/HCA's Richmond hospitals have long histories of implementing the latest information technology, says David Love, director of information systems for the Central Atlantic Division of the Tennessee-based company.

"Overall, it's a big plus," says Marilyn Tavenner, president of Chippenham and Johnston-Willis Hospitals, and a member of Columbia/HCA's corporate steering committee on information systems.

One of the projects Tavenner is most excited about is teleradiology. Of Columbia's five Richmond area hospitals, only Chippenham has a radiologist on site 24 hours a day. Teleradiology enables ultrasound, CT and nuclear medicine images to be sent electronically to Chippenham from the other four hospitals. The radiologist there reads the images and reports back to the hospital where the patient is being treated. As a result, all five hospitals have immediate access to a radiologist 24 hours a day.

"In the old days," Tavenner says, "it meant the radiologist had to get in the car and drive over there. If you can have a two-second read on the film as opposed to a 45-minute [read] on the film, then you don't have the patients sitting in the emergency room twiddling their thumbs."

Another advantage is the ability to manipulate the transmitted image, says Patrick Hoye, radiology director for Chippenham and Johnston-Willis Hospitals. The radiologist can zoom in on areas of interest. "It's just the first piece of teleradiology," Hoye predicts. Ultimately everything from chest X-rays to MRI scans will be electronically imaged.

By early 2000, the emergency room, intensive-care unit, neonatal intensive-care unit and operating suites at Chippenham will have teleradiology capabilities. The long-term goal is for physicians to be able to look at the images on their office PCs. "What this will help more than anything is the film-management process," Hoye says. The advance will eliminate the need to physically transport film back and forth.

Columbia/HCA's Richmond hospitals also are piloting a streamlined patient-registration process. The hospitals' central business system uses a high-speed network to interface with the databases of HMOs and verify insurance eligibility information, Love says. The registration clerk receives a reply from the HMO within 20 seconds, and the system ensures that the information recorded is accurate.

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Like other industries, hospitals are leveraging information technology to lower costs and improve quality, says Greg Walton, vice president and chief information officer of Roanoke-based Carilion Health System.

Carilion has focused most of its info-tech efforts on the ambulatory care side, Walton says. The 12-hospital system employs 160 primary-care physicians at 53 locations throughout the western part of the state. All of these physicians are on one billing and scheduling system, and they use a single record number for each patient.

The company plans to follow that same computer strategy for medical records, says Hugh Thornhill, vice president of Carilion Healthcare Corp., the company's primary-care physician group. Carilion has installed electronic medical record systems in three of its doctors' offices, and it expects to bring the others online during the next two years.

Electronic medical records will expedite routine tasks such as handling requests for prescription refills. Under the existing system, the patient calls the physician's office to request a refill. The nurse pulls the patient's chart from the file room, reviews the record, returns it to the files, and calls the patient back to tell him whether or not the prescription can be refilled. If a refill is indicated, the nurse calls the prescription into the pharmacy. With the new system, the nurse can call up the patient's record on the computer while she has him on the phone. If a refill is appropriate, she can direct the system to fax the prescription to the pharmacy.

Once the electronic medical records are installed in all of its physician practices, Carilion will be able to track diseases across its service area. A flu outbreak could be quickly detected, and more timely preventive measures taken. Also, Carilion will be able to spot situations of abuse. Records from the three practices currently online showed a patient was visiting two practices to obtain more drugs. Under the old system, physicians would have had no way of noticing such behavior.

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The key to capitalizing on information technology is to make it part of an employee's regular workflow — not an additional task, says LaDonna Shedor, Centra Health's chief information officer.

Centra Health, a two-hospital system in Lynchburg, uses Palm Pilots to eliminate most of the paperwork required of Centra's clinical engineers. The engineers, who are responsible for preventive maintenance of the high-tech equipment used in diagnosing and treating patients, download their work orders for the day from the main information system onto the Palm Pilots. As they complete a task, they check it off on the Palm Pilot. Then they upload their notes directly to the network at the end of the day. They have created a record of their work without having to put a pen to paper.

Capturing data across Centra's 2,500-computer system is easier these days. Michael Barger, senior vice president and chief information officer, says all facilities in the system, including hospitals, outpatient centers, nursing homes, and home heath care agencies, use the same medical record number for a given patient. As a result, data can be pulled from each facility and organized by patient so caregivers have the information they need at their fingertips.

This approach also captures data needed to run the business and improve quality of care. For example, management can create maps showing the geographic origins of Centra's patients and make informed decisions about what services should be offered and where they should be located. A Centra physician even used the critical-care database to evaluate a new protocol that helps get patients off ventilators sooner. By comparing information on average lengths of stay, complications and mortality rates, he was able to demonstrate that the new protocol was producing better outcomes.

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Microsoft's Bill Gates highlighted Sentara Healthcare's intranet-based application for physicians in his book, "Business @ the Speed of Thought."

Called SpinWeb, Sentara's system gives 1,615 physicians and support staffers access to information from its hospitals and health plan. Carla Bryant, Sentara's director of emerging technologies, says the company is currently working with Eastern Virginia Medical School to develop continuing medical education programs that physicians can take via SpinWeb.

Sentara has created a similar intranet application for its employees called WaveNet. The company employs more than 14,000 people, and WaveNet receives 1 million hits a month, Bryant says. Employees can check on everything from their retirement plan accounts to the cafeteria menu for the day. They can access an internal phone directory or review clinical policies and procedures. They can even order business cards and process expense accounts.

The system provides kiosks at various sites, so employees without PCs can access the program, too. Sentara also is trying to leverage WaveNet to deliver more services on SpinWeb. For example, physicians can use SpinWeb to access the pharmacy channel on WaveNet and find out what new drugs have been added to the system's formulary.

The next step is to bring the patients online. Ultimately, information technology should enhance the dialogue between physicians and patients, allowing patients to dynamically interact in their own care, says Bert Reese, Sentara's vice president for information technology. Sentara is testing a prototype application that gives patients online abilities to schedule appointments, find health care information and view test results.

Reese hopes to see this system in place within three years, and he expects the pace of info-tech innovation to accelerate in the health care industry. "We're really at the introductory piece of this," he predicts. As the baby boomers enter their 50s, their need for health care services will increase, and the industry must find affordable and creative ways to meet that demand, Reese says.

Shedor, Reese's counterpart at Centra Health, agrees that the best is yet to come. Right now, Shedor says, "There's more good ideas out there than time."