The Paperless Hospital -- Really! - Computerworld

The Paperless Hospital -- Really! - Computerworld: "At bedsides, nurses use wireless devices on wheels, or WOWs, to record progress notes and check doctors' orders. If they administer medicine or change a bandage, the supplies they use are electronically tracked and matched by bar code to individual patient records, enabling more accurate patient billing and automatic inventory replenishment.
What's conspicuously absent everywhere is paper. And for a busy hospital whose staff has just a few weeks of experience working in a totally electronic environment, the overall atmosphere is strikingly tranquil. The doctors and nurses seem completely confident and competent in their new digital workplace."

Steve's Commentary
I've had family members in three different hospitals in as many months. Out of these experiences, I noticed two things that could have been greatly improved:

1. Data Management
A patient is repeatedly asked the same questions -- whether they relate to their condition, their insurance, or their treatment. If the answers to these questions are recorded, they are not available at the point of service. That is, near the patient. Rather, it is on a computer screen at the nurses station or who knows where. Only the doctor who admitted the patient, and perhaps the nurses seemed to have the big picture. Even then, the information was not available to them in the patient room. For example, nurses would measure vitals every four hours. However, without going back to their station, they had no knowledge of the previous stats that had been taken. That meant they would usually ask the patient what the last vital said ("What was your temperature last time we took it?").

Beyond that, none of the specialists that were giving treatments appeared to have a high-level knowledge of everything that was going on with the patient. For example, the respitory specialist just knew that they needed to check with the patient every four hours to see if treatment was needed. They were not aware of any of the other treatments that the patient was undergoing.

2. Setting Expectations with Scheduling
The single most annoying factor of these hospital experiences was the sense of helplessness and chaos. People were constantly coming into and out of the rooms doing their individualized tasks. It was almost like you never knew what to expect next, even though so much of it was on a schedule. For example, here is a list of some of the things that occurred on a regular schedule:

a. Vitals Taken
b. Medication A administered
c. Medication B administered
d. IV refreshed
e. Meals served
f. Visiting hours/Cafeteria hours

Other things happened a little more asynchronously:

a. Primary Doctor Visits
b. Procedures scheduled (X-ray, ultrasound, etc...)
c. Rooms cleaned
d. Personal Care at patient request
e. Waste measured

If all these things could have been layed out on a schedule that was easily viewed by the patient, it would have given a comforting sense of order. It would allow the patient and family to set their expectations and prepare themselves for what was to come, not to mention being able to look back and see all that has transpired.

In one instance, I tried to fight some of the chaos by logging everything that took place on a piece of paper posted on a tack board in the patient room. The primary doctor thought it was great, and referred to it whenever he visited. This simple log gave him an aggregate view of the patients activities and statistics. Perhaps this information was available somewhere else, but we weren't aware of it, and our paper log impacted some of the doctor's decisions. An electronic system with a flat-screen would be great, but a simple pad of paper would suffice. This was an easy solution to a big problem. BTW - Put two patients in the same room and double the chaos.


Some other observations:

a. Most patients are hooked up to an IV and often other devices as well. The tubes and cords really limit the mobility of the patient.
b. The visitor seating in the room was four uncomfortable wooden chairs (2 for each patient). These chairs were in the way when the patient tried to move around the room with their IV poles. A fold-down bench/cot would have been more functional and less obstructive.
c. The supposedly "comfortable" chair in the room was a recliner that didn't go flat and creeked loud enough to wake up the patients next door. Try sleeping in one of these things.
d. Sanitation and cross-contamination is a problem -- the janitorial personnel warned us not to let anything (including bare feet and purses) touch the floor. The nurse warned us not to let bare skin touch the "comfortable" chair because so many sick people sit/sleep in them all the time.
e. The only public Internet access in the hospital was a few kiosks in the main lobby. Not even a wireless network in the cafe.

When someone you love goes into a hospital, you and your family try to rally around that person. It has been my experience that you drop everything and spend all of your time at the hospital to support them. Unfortunately, hospitals are not setup to accomodate the families of patients. Whether it be in the waiting room or the patient room, there is a lot of room for improvement in these facilities. Fortunately for us, we were just trying to pass the time while our patient rested and recovered. During that time, I would have appreciated being able to carry on my normal work activities using VPN on my wireless laptop while sitting in the patient room. This would have allowed me to get some things done and provide the emotional support that physical proximity brings.