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Steven Pearlstein

Innovation Comes From Within

By Steven Pearlstein
Friday, March 4, 2005; Page E01

At 9 a.m., Dr. Julio Panza begins his rounds at the coronary care unit at Washington Hospital Center. Residents and fellows review the status of the 14 patients in the unit. Panza takes notes and records his diagnoses and orders with a pen, as doctors have for centuries.

Discussion turns to one particularly vexing case, a patient admitted the previous afternoon with chest pains. Panza turns to a computer screen and calls up the patient's lab results, which have been transmitted by lab machines. Another click and he can see what medicines have been dispensed from the unit's automated medicine cabinet. Yet another click and the group watches a video of what happened the day before as doctors threaded a thin wire through the patient's arteries and installed three tiny stents to keep the passageways open. Panza clicks again to find details of previous hospital visits and learns that the patient was a heavy smoker and diabetic.

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What the folks at the Washington Hospital Center have discovered is that most of the makings of an electronic medical record are already available in digital form at most hospitals. By investing a relatively small amount of time and money, they've collected it all in one database and designed an easy-to-use interface that allows nurses, doctors, medical researchers and finance staff to organize it in almost any way they want. It's called Azyxxi (don't ask), and it's one of the most advanced systems for managing patient care in the country.

It is noteworthy that Azyxxi did not come out of the hospital's IT department, after the appointment of a task force, the drawing up of a detailed needs analysis and approval of a long-term capital budget. There was no request for proposals, no campaign to win "buy-in" from staff, nor was a dime allocated for training. The system was designed largely by two extraordinary doctors who were lured from George Washington University a decade ago with a mandate to fix an under-performing emergency room with nine-hour waits, dissatisfied patients and an unhappy staff.

Mark Smith and Craig Feied quickly discovered that the main reason for the frustration and wait times was the delay in getting test results and other information to ER doctors and nurses. For Smith, who came to medicine from a PhD program in computer science at Stanford, and Feied, who started his career as a biophysicist and knows 25 computer languages, the obvious answer was to write a computer program that could eliminate the bottlenecks.

Sixteen months later, they installed the first terminal in the middle of the ER with a handwritten sign taped on it: "Beta Test. Do Not Use." But as they had hoped, people began using it anyway -- and were astounded by what they could do. And before long, doctors were coming from other departments to retrieve information on patients who had come to them through the emergency room.

Over the next eight years, Azyxxi spread through the hospital as more people used and demanded it, and more information was fed into its database. By 2002, the IT department threw in the towel and canceled a contract with an outside vendor to develop a hospital-wide electronics record system, having already spent $8 million. By the end of last year, with the help of a handful of in-house programmers, Azyxxi had been rolled out in all six sister hospitals in the MedStar system, at maybe a third of the cost of what an outside supplier would have charged, according to hospital officials.

Now, Smith and Feied have won a federal grant to help create a regional health information network that will tie together the medical records of all the hospitals, labs and doctors' offices in the region. What they bring is not only an open, flexible system that can be a centerpiece and model. They also bring the knowledge that you don't have to pay outside vendors a lot of money, or have a "grand solution," or create a lot of bureaucracy and regulations to bring health care into the information age. Just build it and they will come.


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