November 1, 2008
Not too long ago it was not uncommon for drug reps, sometimes two or three a day, to swarm into a doctor’s office with a small banquet of goodies in hand, along with pens, mugs and other promotional paraphernalia to secure a few precious minutes with the doctor to pitch their company’s latest antibiotic or pain killer.
These days, doctors rarely have any free time during office hours. As a result, more and more doctors are searching the details about a new drug or the results of a clinical study after hours, via the Internet or through a Web-based meeting. On that rare occasion when a doctor has a face-to face encounter with a drug company, the rep is usually armed with a Tablet PC loaded with state-of-the-art software that includes slick graphics and multi-media capabilities.
Searching out information through new high-tech channels is just one example of how technology is transforming American medicine. Pressure to reduce medical errors is one of the biggest catalysts driving the push toward technology. From bedside bar code scanners in hospitals to computerized physician order entry (CPOE) systems, technology is changing the face of medicine. In addition, the percentage of Americans who receive their medical information online through Internet sites such as WebMD is on the rise. According to Manhattan Research, more than 145 million US adults used the Internet to research health information in the past year — a number which has grown each year since 2000. The number of consumers searching for pharmaceutical information online has also increased to 95 million, up 16 percent from last year. The patient or physician who doesn’t keep up with technology is at a distinct disadvantage.
The Joint Commission, America’s most powerful hospital accrediting body, publishes its National Patient Safety Goals annually that highlight problematic areas in health care and offer solutions. One goal the Joint Commission set for 2009 is to improve the accuracy of patient identification. “The fact that this has been the number one goal for the past seven years suggests that we are not making adequate progress,” said Mark Neuenschwander, co-founder of The unSUMMIT for Bedside Barcoding. “I know of nothing that helps hospitals achieve this goal more than bar code ID scanning at the point of care,” said Neuenschwander, who has been on a mission to bring hospital leaders together to learn how to apply technology for a safer point-of-care environment.
Neuenschwander said that bar code ID scanning is to patient safety what seat belts are to automobile safety. “Not the only thing, but a salient thing. We still must drive sober and defensively. Our cars need good brakes and tires. Nurses must read patient wristbands, charts, and drug labels and use their best clinical judgment. But when all is said and done, bar coding, like seatbelts, saves lives.”
When the Institute of Medicine (IOM) released its landmark report on medical errors in 1999, it called upon the healthcare community to embrace technology as a way to help increase efficiency, cut costs and reduce medical errors. The report stated that more than 2 million serious medical errors occurred each year in the United States.
Nine years later, hospitals, pharmacies and individual physician practices have made significant headway in adopting various technologies. However, health care still lags behind other industries — such as aviation — when it comes to utilizing technology as a method to reduce errors and near misses.
Patient safety experts have been pushing for the elimination of paper-based prescriptions and the creation of an electronic medical record (EMR) that could be accessible anywhere throughout the healthcare enterprise. CPOE cannot only help establish an electronic record, but it would also contribute to the reduction in the number of errors at the prescribing stage.
Yet, according to the Leapfrog Group, (a consortium of corporations dedicated to reducing healthcare costs and medical errors) only about 6-8 percent of hospitals nationwide have CPOE. Studies show that if CPOE were deployed and used properly, it could reduce medication errors by between 50-100 percent.
Bar code scanning of drug labels (a common technology used in the retail sector), at the point of administration, has a proven track record of helping to assure that a nurse is giving the right patient the right drug, the right dose and the right route of administration at the right time. The Veterans Administration health system, for example, has had remarkable success in reducing errors with bar coding. Yet less than 15 percent of hospitals in the US have bar code systems in place.
But there is good news on the horizon when it comes to increased utilization of technology in the healthcare sector. Fueled in part by The Joint Commission’s pressure on hospitals to adopt technology that would lead to a reduction of med errors and adverse events — and the threat of costly litigation — more and more hospitals are embracing bar coding, CPOE, and electronic medical records. In addition, there has been a spike in the reporting of medical errors, adverse events and near misses to national reporting programs, including FDA’s MedWatch and the USP-ISMP reporting program. Data from these reporting programs help patient safety experts to track patterns that can lead to medical and medication errors and provide ammunition to pro-technology advocates.
Duke, UNC At The Forefront
In the Triangle, two of the leading healthcare systems, Duke and UNC, have already adopted state-of-the art technology or are in the process of bringing new systems onboard.
In the UNC Health Care System, all inpatient units have been using CPOE for the last four years. The outpatient units have CPOE for all drug prescribing, including direct electronic communication to outside pharmacies that can accept direct transmission of prescriptions into their systems.
CPOE markedly improves patient safety by alerting physicians to drug interactions, drug allergies and drug therapeutic duplications, said Dr. Robert G. Berger, professor of medicine, director of Medical Informatics at UNC Health Care System. Berger, who is associate chief of staff, noted that CPOE speeds up the whole process of ordering.
For example, before CPOE, a physician would order an EKG and a piece of paper would have to be filled out by a ward clerk and sent to the EKG lab where a technician would be sent to the floor, a process that could take up to an hour. Now, the order goes immediately to the pager of the EKG technician who can simply go to the patient’s room.
“Sometimes the physicians will put the order in electronically and the technician is up on the floor as the physicians move to the next patient’s room. The same goes for the time it takes to get antibiotics up from the pharmacy and infused into the patient. This clearly results in faster therapy for infectious diseases,” noted Berger.
He added that UNC is basically a “paperless” institution. The facility has had an EMR for the last 18 years. “We have just completed all of our nursing and ancillary notes and flow sheets from paper to electronics as part of this electronic medical record.”
One of the benefits of the EMR is to have complete information available on any patient from anywhere in the world because the application is Web-based. Another patient safety benefit of EMR is that doctors can electronically adjudicate the medications the patient came in using with the meds given during the hospitalization to provide an accurate list of discharge medications.
This list automatically, electronically passes to the nursing notes, and the nurses give the patient educational materials on the drugs that are sent home. In addition, when patients return to the institution for their follow-up visit, their medication list on the EMR is accurate. “This is very important as the medical literature tells us that the most risky time for the patient is at discharge when medications can be duplicated, omitted or other errors can occur. The EMR with its CPOE and nursing components obviate this risk,” said Berger.
Over at Duke Raleigh Hospital, smart IV pumps (computerized IV infusion pumps) and a pharmacy automation system are in place and the addition of an anesthesia workstation and an automated drug restocking carousel is slated for installation in near future, said Gene Woodall, director of pharmacy.
Woodall said that smart pumps provide safety “guardrails” that are loaded with drug-dosing and rate parameters that cannot be exceeded. “This prevents a patient from getting a significant overdose or underdose of medication.” The automated drug cabinets (ADC) are designed to only allow the nurse to retrieve the drugs that his/her patient is currently prescribed and whose orders have been reviewed by a pharmacist. “Once the pharmacist enters the medication order as prescribed by the physician, the drug is then activated for that patient in the ADC on the unit where that patient is receiving care. The carousel that is planned for our pharmacy will help with inventory control and assist in assuring that the pharmacy loads the ADCs accurately,” said Woodall.
A 2005 survey conducted by the American Society of Health-System Pharmacists revealed that patients’ number one fear upon entering hospitals was receiving the wrong medications. That fear is well founded. Research shows that nearly one in five medications is administered in error.
While hospitals are under increasing pressure to cut costs in a highly competitive environment, they are also under the microscope when it comes to finding ways to reduce the number of medical errors and adverse events. Technology isn’t the panacea, but is it a valuable tool that’s helping them to reach that goal.
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Internet Assists Doctors As Source For Health Information
More US adults used the Internet than doctors to obtain health and medical information over the past year, according to pharmaceutical and healthcare market research company Manhattan Research. This trend represents a noticeable change in consumer behavior from previous years, as doctors have traditionally been the top source of health information.
This finding comes from Cybercitizen® Health v8.0, a market research and strategic advisory service focused on how consumers use media and technology for health information and its impact on treatment and product decisions.
“Though doctors remain an essential part of an individual’s health management, consumers are increasingly comfortable using the Internet as a research tool for condition and treatment information,” said Meredith Abreu Ressi, vice president of research at Manhattan Research. “As healthcare coverage — and even routine visits to the doctor — becomes less affordable to many Americans, the Internet has emerged as a first line of defense for consumers seeking to manage their healthcare independently.”
Manhattan Research hosted a webinar event, “Is TV Dead? How the New New Media Changes Pharmaceutical DTC Advertising,” on Oct. 14 and Oct. 16. The webinar will help pharmaceutical and healthcare marketers understand the optimal media mix in the face of an uncertain economy. Abreu Ressi overviewed key market data and trends from Cybercitizen® Health v8.0.
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