Emergency Care Gets Online Boost at Inova
Hospital Chain Invests Millions in Computers To Track Patients and Improve Treatment

By Susan Levine
Washington Post Staff Writer
Tuesday, December 25, 2007; HE04

Only two months ago, the Emergency Department at Inova Fair Oaks Hospital was piled high with patient charts: files clogged with physicians' notes and nurses' follow-throughs, with test orders and lab results and a plethora of other printouts and paperwork. As in most EDs, keeping track of everything connected with a case could be challenging, especially when a patient's chart was needed simultaneously in different parts of the hospital.

It was all so 20th century.

But those files now are history. Today, from the minute someone comes through the door -- actually, minutes before that for those arriving by ambulance -- that patient's record is electronic. With a simple click, the person's examining room is assigned. Conditions and symptoms are entered. Click, click, click and, from a mobile computer at the patient's bedside, a doctor can instantly send X-ray directives to the radiology staff and drug dosages to the pharmacy.

"The difference is like night and day," says Douglas Smith, the Fairfax County hospital's chairman of emergency medicine.

Fair Oaks is the first hospital in the Inova Health network to convert its ED to an electronic monitoring and documentation system, a move that radically streamlines the management of 42,000 emergency cases annually and the countless reams of paper they generated. Eliminating heft and hassle are just two of the goals. Hospital leaders hope the change will get rid of far more important problems, including medication errors and delays in treatment.

The new system amasses an array of information, updated in real time, and organizes it on a master grid showing the status of each patient and the doctor and nurse assigned. Tiny red letters and clocks call attention to aberrant readings; other alerts signal that test results are available. Consent forms can be scanned in quickly, details of past medical visits cross-referenced. And on discharge, patients can get customized instructions -- for which they sign electronically.

"When you're on paper, you don't even know what rooms are available," Smith recounted.

What ultimately will set this effort apart in the Washington region is Inova's plan to integrate its six hospital EDs and several free-standing emergency centers across Northern Virginia. By next December, at a cost of more than $6 million, each will be online and linked to one another. Staff will be able to track patients from one facility to another, and backers anticipate more comprehensive, efficient care throughout. Inova's sites see 300,000 emergency patients a year.

Many health-care facilities are taking their medical records into the digital age, though at different speeds and often with more modest ambitions. According to Don Detmer, president of the American Medical Informatics Association, half of U.S. hospitals are using the electronic records technology for documentation. Less than one in 10, however, have gone beyond that to allow computerized ordering of tests and prescriptions. And even fewer have electronically tackled the fast-paced, unpredictable and crowded setting of emergency departments, "probably the most intense" environment in a hospital, Detmer noted.

George Washington University Hospital upended its ED in 2005, choosing the same software program as Inova. "It's a godsend," said Robert Shesser, who leads emergency medicine there. Nobody misses the paper past: "The old cry around the nursing station -- 'Where is Mr. Smith's chart?' -- is no longer heard," Shesser said.

Inova made Fair Oaks the test case because, at 182 beds, it is the organization's second-smallest hospital and could better handle any start-up glitches. Another reason was Douglas Smith, an enthusiastic proponent who seldom is without the hand-held computer that connects him to the system. Some of his colleagues are equally facile with the device, which is not much larger than a child's Etch A Sketch, but others are using the units that can be wheeled around the Emergency Department.

"The docs are getting better at it, the nurses are getting better at it," Smith said with a laugh last week. "Though we're still getting iterations of 'I didn't know we were supposed to do it that way.' "

More than 520 people at the hospital have been trained and authorized to use the system. Inova says it has adequate protections to ensure the privacy of the records they view. Anyone who logs in and calls up a patient chart leaves an electronic fingerprint that can be readily traced -- in contrast to what happens with paper records, officials point out.

Charge nurse Rachel Godfrey approves of the epochal transformation. "It speeds up my job," she said on a recent afternoon shift. Not only does she no longer have to chase charts, she doesn't have to worry about a physician's illegible handwriting or a medication order with a misplaced decimal.

Safeguards make prescribers choose a specified dosage based on the drug they select -- and the program checks it for potentially dangerous interactions with other medications the patient is taking.

"That's a huge benefit," Godfrey said.

A few vestiges of the previous era remain. Still hanging at the department's central crossroads, blank and abandoned, is the giant white greaseboard on which patients' names and statuses were once written in colored marker. And the little Velcro-backed pictures that would be stuck beside a name -- a bed for a pending admission, an upside-down house for a person going home, and so on?

Tossed, forever. ¿

Comments:levines@washpost.com.