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Insert Comma • A Portfolio of Leigh E. Rich
The new CAD

Computer-aided doctoring

By Leigh E. Rich

“I have the courage to run for the United States Senate,” Republican hopeful Pete Coors told a small envoy that toured Denver Health’s facilities in September, “largely because of Dr. and Sen. Frist.”

Senate Majority Leader Bill Frist, a heart surgeon and a Republican from Tennessee, joined Coors and his wife Marilyn, a bioethicist, last month for an inside look at Denver Health’s medical intensive care unit (ICU)—and a quick stump to encourage Colorado to send a Republican to fill Ben Nighthorse Campbell’s vacated seat.

Though both Frist and Coors held a brief press conference about what Coors, “as a businessman,” would bring to the Senate and the question of America’s health care crisis, the main event of the afternoon was a firsthand peek at Denver Health’s electronic medical record system.

Heading the tour were Dr. Patricia Gabow, Denver Health’s CEO medical director; Dr. Richard Albert, director of medicine; and Dr. Andy Steele, director of medical informatics.

Gathered around a computer terminal in the second-floor medical ICU, Steele and Albert demonstrated all of the bells and whistles an electronic record system offers doctors and nurses, including timesaving automatic entry of standard procedures, prompts to enter verbal orders, and alerts about possible allergic reactions and drug contraindications.

Implementing such a system in all of America’s hospitals, advocates say, would reduce medical errors and time-consuming and costly paperwork.

According to a 1999 Institute of Medicine study, between 44,000 and 98,000 people die every year because of medical errors. And, compared to the Medicare program’s overhead of just 3 percent, more than 24 percent of every health care dollar in the private sector goes to paperwork and other non-clinical costs.

An electronic system, Steele told his political visitors, also will reduce the amount of time a doctor spends giving medical orders, as nurses—who often train residents on how to use this type of system—will eventually be able to plan certain orders that doctors will simply authorize and adjust accordingly.

It may be difficult at first, however, to convince physicians to switch to an electronic system, Steele and Albert admitted, because it does take twice as long to enter orders compared to the old-fashioned way. But they assured Frist and Coors that time is saved on the backside.

For example, documenting all verbal orders—often a source of miscommunication—reduces errors and mistakes. And typed orders often prevent a nurse from paging a doctor in the middle of the night to clarify instructions—because doctors, as the rumor goes, Frist, Steele and Albert shared a knowing laugh, don’t always have the most legible handwriting.

The Denver Health team also emphasized that the electronic method provides better organization, allowing practitioners to easily order additional tests and consultations, such as a chaplain to visit with the patient. With a paper record, Steele explained, the chaplain request form is stuck way in the back and is not always the first thing on a doctor’s mind.

The electronic system even allows physicians to access records remotely and offers an extensive online medical library available at their fingertips. According to Steele, it’s also changing the doctor-patient relationship in small ways, because now patients can actually see what’s being entered into their records.

Health care practitioners and politicians are so hopeful that this technology will reduce medical errors and costs, both presidential contenders George W. Bush and John Kerry support moving to electronic medical records before the end of the decade.

There are some issues to be ironed out, however, Steele and Albert warned. And with Marilyn Coors in tow for the day, Coors and Frist made a point to ask the Denver Health crew about safeguarding privacy and the ease with which a system can be implemented.

Currently, the Denver Health system, Albert explained, has “double key security”—access requires a card that is inserted into the terminal followed by a password. As for remote entry into the system and the online medical library, only practitioners with privileges at Denver Health can sign on.

Such a system is not “plug and play,” Steele told Frist in answer to his question. The system very much needs to be tailored to the individual institution, which is not always an inexpensive or speedy process.

Like proud parents of a newborn, however, the Denver Health team beamed when bragging to Frist and Coors that few hospitals in the United States use an electronic system to this extent, particularly a public facility.

Awed by what he saw that day, Frist applauded Denver Health during the press conference that followed for its first-rate care and its investment in 21st-century medical technology such as electronic records, as well as the “American values of choice and freedom of choice.” 

Rich, L. E. (2004, October 22). The new CAD: Computer-aided doctoring. The Colorado Statesman, p. 15.

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