Thanks to XM Radio, I was able to listen to Sunday's Detroit Red Wings playoff game and the WJR radio broadcast from Detroit (the “great voice of the Great Lakes”).
I heard a commercial a few times that I managed to record and it hearkened back to when I asked this question in a November, 2007 post:
I was wondering the other day about hospital advertising that you might see in your community (TV ads, billboards, newspaper ads). With the focus on improving quality and patient safety, is there a hospital somewhere that is advertising itself as a “safer” or “better quality” option? I don't mean advertising that their doctors are highly skilled or “the best.” That's different than the quality provided through hospitals processes and systems, the operational aspect as opposed to the clinical/medical aspect.
This commercial is the first example I've heard or seen. and it features the CEO of Detroit Medical Center Hospital. Transcript to follow for those without speakers… It starts (before I managed to start recording with my BlackBerry) asking about why many hospitals here in the 21st century use old paper and pen technology to track your medical records and orders…
“…even the McDonald's drive through doesn't use paper orders anymore. Hand writing errors and lost files have proven to cause serious patient harm far too often. This is Mike Duggan…
DMC is proud to announce we are now the first Michigan hospital system to eliminate paper orders. At DMC Hospital, doctors bring a computer to your bedside, and enter all orders electronically. So a medication order is instantly transmitted to the pharmacist, with warnings to prevent dangerous interactions with the other meds. Doctor and nursing care is better coordinated, all working from the same computerized treatment plan.
So if you want a hospital with the latest architecture, go to the other guy. But if you want the latest technology in patient safety with 100% computer orders, go to Detroit, to the DMC.”
Wow, a few things stand out. First, it seems rare to find one hospital criticizing another (or others). I don't blame DMC for criticizing the fancy architecture of some hospitals. I understand there are some cases to be made that certain architecture elements help “promote a healing environment” and that's all well and good, but that seems like something to work on AFTER having fixed some of the fundamentally broken processes that lead to otherwise-preventable patient injury and death. I cringe each year at Modern Healthcare's Design Awards, which seem to focus more on the cosmetic and the beautiful instead of the functional and effective.
There are many ways of implementing the computers required for electronic medical records and order entry. In some hospitals, the computers are room/patient-specific, meaning they're fixed and stay put. I've heard some hospitals make the case that this helps prevent the spread of germs and possible infections. Some hospitals, like DMC, have doctors or nurses roll or lug computers into different patient rooms. Are they wiped down in between rooms? Not always (unless they're VERY disciplined at the DMC). If the MD has a laptop, is there a place to set it? You don't want to put the computer (or anything else) on a patient's bed. I hope DMC has a good plan for this, it's too much to handle in a 60-second commercial (although it would be a great podcast topic, perhaps).
Having computers available in the room (through whatever means) is also very good for nurse productivity, as it saves them from walking back and forth to and from the nurses' station as often (as well as making sure order entry isn't batched, causing delays, as the radio ad implies).
I wonder how the CEO guarantees “100%” compliance with the use of CPOE (Computerized Physician Order Entry). Considering that most physicians are not employees of the hospitals, hospital execs certainly cannot rely on top-down mandates (not that a Lean CEO would use that formal authority route except as a last result). Another Michigan hospital reported just an 85% physician compliance rate.
If it were as easy as “build the software and they will come”, we wouldn't have journal articles with titles like, “Overcoming Barriers to Adopting and Implementing Computerized Physician Order Entry Systems in U.S. Hospitals.” The article cites many barriers:
Physician and organizational resistance was one of the top barriers cited in the interviews. Physicians seemed to believe that CPOE systems would create more work and that the traditional paper-based ordering method was faster. Some hospitals abandoned implementation plans, fearing that physician resistance could escalate to a point of “physician rebellion.” The interviewers also noted low levels of computer literacy among some physicians and a lack of user involvement in implementation processes.
Is paper ordering indeed faster than CPOE? I can't say from first-hand experience. I've heard nurses complain that EMR systems are slower for them than paper charts. Is it suboptimizing to use the method that's faster for the physician even if it increases risk to the patients? Where does the Hypocratic Oath come into play? If you believe DMC, the physicians should feel an obligation to use CPOE.
I hope DMC is not just blowing smoke in their ads…. will they publish data that shows 100% compliance? Is 100% even possible, compared to 99.5%? I hope they are using CPOE in a way that doesn't spread germs and in a way that had the physicians sufficiently engaged and trained so that they would WANT to use this system that is so good for the patients.
What are your views, either as a patient and potential customer of DMC or as someone who works closely with these systems first-hand?
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