Data integration key to healthcare goals

Hospitals using dashboards to gain unified view of patient data

Dr. Julian Goldman of Massachusetts General Hospital plugged a USB drive into a computer so he could give a slideshow presentation at the British Consulate-General in Boston Wednesday morning, and remarked that this simple act exceeds many of the technological capabilities of today’s health care system.

Dr. Julian Goldman of Massachusetts General Hospital plugged a USB drive into a computer so he could give a slideshow presentation at the British Consulate-General in Boston Wednesday morning, and remarked that this simple act exceeds many of the technological capabilities of today’s healthcare system.

“We can’t do anything like that in healthcare,” Goldman said during a panel discussion on healthcare innovation, hosted by the Mass Technology Leadership Council. “We can’t do that with electronic medical records, we can’t do that with the data on our computers.”

Goldman, an MGH anesthesiologist and director of the interoperability program at the Center for Integration of Medicine and Innovative Technology (CIMIT), described how MGH is trying to incorporate plug-and-play interoperability into healthcare with what it calls an “Operating Room of the Future.”

The project helps manage the jumbled mess of technology crowding most operating rooms with a dashboard that provides real-time updates of the information needed during surgery, such as vital signs, room temperature, diagnostic images and progress updates recording key events in a surgery.

One of the paradoxes of automation is that as new systems are continually added, doctors and nurses end up with more screens full of information than they can comfortably observe, said panelist Jeffrey Robbins, founder and CEO of vendor LiveData, which supplies some of the technology used in MGH’s advanced operating room.

“That was the problem presented to LiveData. Can you actually take all the information that’s relevant at a given point in time and display it?” Robbins asked. “Nurses are working with their hands, but they’re increasingly being called over to keyboards to document processes on the fly. … It’s quite challenging. One of our goals was to add no new typing chores. To do that we had to tap into electronic medical records, various IT systems, as well as the various physiological monitors in the room.”

This is important when you consider that a typical operating room is crowded with IV lines, pumps, blood warmers, anesthesia machines, bedside electronic medical record systems and other devices, Goldman said. “This is what it takes to do the job today, and we’re really happy we have these things, but as you can see it’s a mess,” he said. “It’s just easy to trip over the stuff on the floor.”

Better technology integration also allows the coordination of video with vital signs to make it easier to find a recording of whats happened after a patient’s condition changes suddenly, Robbins said.

This is all part of a larger goal to make medical devices interoperable, allowing the healthcare system to be more efficient and improve care of patients, Goldman said.

But propagating these technologies throughout the system remains a challenge, noted moderator Ronald Newbower, co-founder of CIMIT, a consortium of 11 hospitals, medical organizations and universities. The Operating Room of the Future, which opened in 2002, is just a single operating room in a hospital that has more than 50, he said.

Dashboards that track and coordinate patient information also are critical in emergency medicine, which is suffering from staff cuts, waiting times that sometimes reach seven hours, and capacity shrinking to the point in which patients are being treated in hallways, said Dr. Jason Tracy of the ER at Beth Israel Deaconess Medical Center in Boston.

“We’re the one place that has to stay open 24/7 and regardless of what’s going on, we must treat and see every single patient that walks in our door, by law,” Tracy said. “We have a very unique care environment that needs new technology to care for these patients.”

Beth Israel uses an emergency department dashboard to manage the flow of patients and integrate medical records with vital signs, he said. The hospital also has started a wireless data capture initiative to monitor patients remotely. Since doctors typically have little time to see each patient, hospitals need to implement “smart” alerting systems that tell them when a patient's vital signs are abnormal, he said.

Dr. David Judge, a primary care doctor at MGH and director of the hospital’s Ambulatory Practice of the Future project, is planning a pilot project that will remotely monitor blood glucose levels and other statistics on a group of diabetic patients. Judge also wants to have appointments with patients via telemedicine and a medical records system that lets patients more easily keep track of their own care.

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