Digitization at the Hospital

Due to a sick family member, I recently had the occasion to spend time at one of our local hospitals. If you've ever been through that, you know that it involves a lot of waiting around, which gave me a lot of time to fill. Being a geek and interested in digitizing my own life, I found myself fascinated with how the hospital used digital methods to facilitate patient care and record keeping. As far as I can tell, different hospitals have engaged with digital methods to varying degrees so I'm definitely writing about a sample of one.

The most visible thing is that patient care records and the gathering of the data for them are almost completely digital. Every nurse has a WiFi enabled mobile workstation containing a computer and bar scanner. The nurses drag these with them wherever they go. When nurses need to give a patient some medication, they first scan the patient's wristband. The patient's name comes up on their workstation along with their chart. Next they scan the medication package and the computer verifies that the medication and dose is proper.

Although it's not obvious from the picture, the workstation's height is easily adjusted—think adjustable standing desk—so that they can lower the workstation, sit down, and work on patient charts. Any RN will tell you that their job is mostly about paperwork so they spend a lot of time working on those charts at their workstation.

Physicians don't have individual workstations but there are stationary computers scattered about the ward where they can enter their notes and instructions into the patients' charts. They generally do this right after seeing a patient so that the charts are always up to date. That's important because lots of different people are reading and taking guidance from the charts.

At least in my family member's case, a nurse or patient care technician came in to take vital signs every hour. Once again, the process is completely digital. They bring in another mobile cart that has a digital spot monitor and bar scanner on it. As with medication delivery, they first scan the patient's wrist band. Then they hook up the blood pressure, pulse, temperature, and other receptors and capture the patient's vitals. These are displayed on the monitor and automatically added to the patient's chart via WiFi.

Some patients require EKG monitoring. In those cases, the patient is wired as usual for an EKG but the leads go to a small WiFi device that transmits the results in real time to a monitoring station. At this hospital, the monitor stations are on a different floor and monitored by people with no other duties. If the device is disconnected (say for a shower or a medical procedure out of the ward) the nurses call the monitoring floor and tell them the patient will be off monitoring for a while. If the patient doesn't reappear on the monitors within a specific time, the monitoring personnel call the nurse to find out what the problem is. Again, these results are fed into the patients' charts.

One thing that struck me as odd is that the nurses' station had a pneumatic tube delivery system like those used at drive-in banks. I asked one of the nurses why they had this given that all their paperwork appeared to be digital. She said they used it for sending blood and fluid samples to the lab and for getting drugs from the pharmacy. She said they couldn't live without it because when it was down they had to hand deliver and retrieve those items. Given that this hospital had 8 floors, the utility of the system becomes clear.

The anomaly in all this digital record keeping was personnel type records such as schedules, time in and out for breaks, and duty assignments. As far as I could see by snooping at the nurses' station, these were kept on paper logs on clip boards just as they have been for years. I don't know why that isn't digitized too—it seems to me to be the easiest thing to keep as digital records even if only as a spreadsheet.

To my mind, this digitization of patient records is a huge step forward but a recent Vox article shows we have a long way to go. The first problem is that 40% of hospitals still aren't using digital records. The bigger problem is that the systems the hospitals use are incompatible so that records can't be shared. The ideal is that a physician anywhere in the country (or world for that matter) could pull up your records and see your medical history, what drugs you're taking, and any other medically pertinent information. Imagine yourself unconscious—an auto accident, say—and you can see how this might be a life saver.

I expect that things will get better. More hospitals will digitize—although there is resistance on the part of physicians because the systems can be hard to use—and standardized record formats will be developed so that the records can be more easily shared.

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