Looking for the latest in state-of-the-art medical and information technology? Look no further. It's right here in Baton Rouge. Recent interviews with area hospitals reveal that many are on the cutting edge of new  technology –implementing electronic systems and utilizing diagnostic and treatment tools that are unparalleled elsewhere. Some are serving as prototypes for other medical centers around the country. Others are working at the design level on technology that isn't available anywhere else. One thing we found in common with all of them is that they are very excited about their new technologies and welcomed the chance to share their experiences in selecting, designing, and implementing them. Here are a few highlights.

 

Woman's Hospital

At Woman's Hospital, the staff has been involved in the creation, integration, and adaptation of their electronic information systems. From bedside charting on mobile carts, to patient tracking, to electronic medication checks, the hospital is rapidly becoming very “wired.” “We always had electronic information,” said Paul Kirk, Director of Information Systems (IS), “but it was never interconnected before.” Now the information flows between departments and provides a “big picture” look at where the patients are and what they need. It has also enabled the hospital to provide the patient with an itinerary of her stay, allowing a better understanding of what is going to happen, and when. “We're most excited about the increased level of communication between departments and between nurses and patients,” said Lori Denstel, Director of Nursing Systems. “Now that we have this system we realize how much time we spent on the phone trying to find a room for a patient, discover if a specific task had been completed, or requesting that someone complete that task. Now we pull up the electronic bed board and all that information is there.”

 

The bed board actually was created at Woman's Hospital out of dire need, during Katrina. Swamped with patients, most of whom had no medical records, and fielding constant calls from outside the facility on availability of beds, patient status, and discharges, the old paper chart on the door method wasn't working. In 48 hours, a crude version of today's bed board was up and running. Now, a doctor, nurse or administrator can access the web-based site and see at a glance, what rooms are available, what tasks have been completed, what tasks have not been completed in the anticipated time frame, whether labs have been done or results are available, and much more. Updated every minute, the bed board gives a very real time overview of the hospital. It can also be used to track efficiency, highlight problem areas, and forecast availability. It saves time and trouble for all stakeholders, eliminating the need to physically check or call for status. The hospital now gives patients a much better idea of when certain things are going to happen, such as a hearing test, baby pictures, even discharge, which helps them feel more involved with their care plan. “It also keeps us honest,” laughed Denstel, “because it is all right there on the screen.” With everything automated, with alerts and reminders built in, less information and fewer tasks fall through the cracks.

 

Kirk said that one of the unique things about the system is that it is designed specifically for their hospital and that the nurses who will use the system the most were integrally involved in its design, going so far as to “road test” the mobile carts. Even now that it is up and running, nurses are encouraged to go online and post comments, suggestions, and questions, to continue to fine tune the system. That sense of ownership and the fact that it was not designed by IS and pushed out of that office onto the patient floors, but designed by the nurses themselves, has made the system a success, said Kirk. Now ancillary departments are clamoring to be part of the system, as it features information they feel would be helpful to their operations as well.

 

As the hospital continues to build on the system, a method to track patients rather than rooms will be accomplished through ultrasound readers and electronic tags attached to equipment that travels with the patient. Right now, the board will indicate if a room is assigned, but not necessarily that the patient is in the room. The ultrasound readers will indicate exactly where in the hospital the patient is at any given time. Medication administration will also be electronic, with the ability to scan both patient and medication information and confirm a match. The system will not only ensure that the right patient gets the right dose of the right medicine, but will also issue alerts for timing of the medication, contraindications, etc. “Every time we add a building block we go back and re-validate what we are doing already, to make sure it is a fit,” said Kirk. For example, when the electronic medical administration record was created, the staff  realized that medications aren't bar-coded by dosage, the hospital receives them in bulk. The hospital had to find a way to integrate the medicine into the system. Certain things like breast milk for NICU patients posed more complicated matching challenges as dosage and freshness issues came into play. In addition, medication matches required an electronic ID on the patient, but if the patient is a tiny premature infant, how do you attach the ID? That particular challenge became a quest, involving months of input, design changes, prototypes, and finally a specially crafted bracelet made just for Woman's Hospital, which has since been picked up by other hospitals with the same challenges.

 

The hospital also worked on an electronic medical record system through a grant with the Department of Defense to design a high risk OB electronic military record for a military OB/GYN facility. Because of the similarities of that facility with Woman's unique patient base, it also helped Woman's develop their own. It will be launched this month and will offer local physicians with privileges at Woman's Hospital access to the system. Under the system, physicians will be able to relay all pertinent medical, treatment, and prenatal records to Woman's upon the patient presenting. By prepopulating the patients' hospital record with this information, the best possible care will be provided and staff will have all the pertinent information upon admission. In addition, after discharge, the original physician will be able to electronically access all of the additions to the patient's record made during her stay. These physicians will pay 15 percent of the system’s cost, but excitement is high already because of the improved information flow and patient care it offers. Under guidelines laid out by the Office of the Inspector General and by the Stark Law, the hospital must walk the fine line between being required to offer physicians something they don't already have (meaning those with sophisticated EHR systems in place already can't participate) and not being seen to entice them to participate. “Ownership of the data is also a sticky question, on which the feds have failed to make a clear ruling thus far,” said Kirk. “Does the data belong to the patient? The physician? The hospital? Is there certain information in the health record that it would be better if the patient did not know at this particular time, such as a possible genetic predisposition to a disorder later in life? Are there liability issues in who sees this information?” For now hospitals implementing EHR must ensure their program follows HIPAA and that the data is kept secure.

 

Finally, the hospital plans to launch electronic check-in for the Breast Center early this year. Patients will be able to complete their own registration, fill out the appropriate paperwork, and even pay using an electronic tablet. The information is stored electronically, so it can be accessed by the registration desk while the patient is working on it, stored for future visits to avoid repeating the questionnaire each time, and tracked by administration to ensure quality care. This advance was actually spearheaded by CEO Teri Fontenot, who felt that asking patients to answer the same questions every time, especially on a return visit for a diagnostic mammogram, was not the most sensitive patient care. The Woman's Touch electronic check-in is very user friendly, allowing the patient to back out any time or summon a staff member for help. The program even allows patients to complete Medicare/Medicaid forms, permission forms, and complete payment by check or credit card on the electronic tablet. Best of all, the information becomes part of the patient’s EHR and future visits will only require updates not a complete do-over.

 

Ochsner

Unlike most hospitals, the folks at Ochsner are not so excited about their electronic medical records system because it is new, but because it is not. “Ochsner has actually been storing patient information electronically for 20 years,” said Dr. Jay Brooks, Chairman of Hematology/Oncology. Lab tests, x-rays, and doctor's notes were all kept in an electronic depository. One of the things that attracted Brooks to Ochsner years ago, was that all of the doctors worked out of a common record, making it easy to track all the care the patient had received. However in the last 5-7 years, great strides have been made in improving organization and access to that information. That put Ochsner ahead of the curve. Everyone is working on electronic health systems now, but Ochsner already had theirs in place before Hurricane Katrina. As evacuees sought treatment in other areas of the state and country, many people found that their physicians had evacuated and/or their records were lost due to flooding. However, nearly all of Ochsner Health System's 300,000 patients found their medical records safe and easily accessible thanks to an electronic record system: Ochsner Clinical Workstation (OCW). OCW allows medical files to be retrieved from any Ochsner location throughout Southeast Louisiana. Physicians can also access the system essentially from anywhere that they have internet access.

 

“I think our electronic medical records really had their shining moment during and after Katrina,” said Dr. Brooks. “I treated many New Orleans patients who evacuated to Baton Rouge. One in particular could only describe her medications by color and size. I was able to pull up her profile on OCW. She was undergoing chemotherapy, radiation, and was a heart transplant recipient. Once I had all of the pertinent information I was able to treat her appropriately. Here was a woman who had left New Orleans with little more than her husband and her car intact. She wept when she found her medical records had survived as well.”

 

OCW is also unique in that it profiles the patient from birth to death, not by specific, episodic, medical events, such as stroke or heart attack. This format allows physicians to manage their patients longitudinally; looking back 20 to 30 years, to identify historical information to treat them more effectively. “With most systems in use in major hospitals, the information is event-oriented rather than patient-oriented,” said Brooks. “With ours, the data follows the patient not the specific event or admission.” The system required a learning curve for the doctors, nurses, and technicians, said Brooks. “If the information is not entered into the system or captured electronically, it for all intents and purposes never happened. Similarly, the information in the system is only as good as the person entering it, so incomplete or inaccurate data is unacceptable.”

 

Brooks attributes much of the success of Ochsner's system to the fact that it is physician designed, tested, and critiqued. “What's the use of having a great system if the docs won't use it?” said Brooks. While inpatient doctor's notes are still written in the chart, electronic charting at the bedside is coming soon. All dictated notes and all notes taken in the doctor's offices are captured electronically. Ochsner is also exploring ways to allow patients access to their records electronically. Certain outside physicians also have contractual agreements with Ochsner to access the database for their patient information. The system can also tell the doctors at a glance, how many patients they have, what beds are empty, etc. Patient names and diagnoses are never posted on these screens.

 

Despite these advances, Ochsner has found that the biggest nation-wide challenge in medical record technology is creating a universal language to allow major medical centers the ability to communicate with each other. For the most part, electronic medical records are limited to single hospital systems and there are no guarantees the databases can “talk to each other.” However Ochsner and M.D. Anderson Cancer Center are trying to address that by participating in a pilot program sharing electronic communication on patients that both centers currently treat. Ochsner is also participating in a Louisiana Department of Health and Hospitals project to develop electronic clinical information exchange between South Louisiana providers called LaHIE. 

 

Outside of IT, Ochsner is also excited about some new treatment technologies. The hospital is the first facility in Baton Rouge to take advantage of a new technology called Navigation to perform total knee replacements. What makes this system unique is its similarity to GPS technology, using several mechanisms to transmit signals to the receiver to determine information. Navigation's mechanisms aren't GPS satellites, but instead, a computer, infrared camera, and wireless instruments that give the surgeon (the receiver) an exact view of his instruments in the patient's anatomy. These visuals allow surgeons to perform a more precise alignment of the knee than ever before. Without this technology, the traditional procedure relies on more invasive techniques and the surgeon for alignment. Navigation has also been used nationally in neurosurgery, spine, ENT, and trauma procedures.

 

Ochsner Medical Center-Baton Rouge is now also offering patients a minimally-invasive form of treatment that could eliminate the need for amputation. The new Excimer or “cool” laser produces pulsed bursts of ultraviolet light energy capable of vaporizing plaque and calcium into tiny particles that are easily absorbed into the blood stream. This new laser technology is a minimally-invasive method of eliminating the buildup in arteries and veins, thus reducing symptoms and possibly saving the limb from amputation. The energy in the laser is transmitted along flexible glass fibers encased in catheters, which can be passed through arteries and veins. The UV light energy is focused only on blockages that need to be treated. In contrast to the long recovery time required after bypass surgery, this procedure is performed within one or two hours with only minutes of laser use, followed by just one or two days of recovery. 

 

Finally, Ochsner Medical Center-Baton Rouge reports that it is the only local facility with the latest high-definition endoscope. This new system provides sharper definition and clearer images of the body's internal organs and systems. This technology is able to produce such in-depth images by utilizing HDTV and narrow band imaging, a technique that manipulates tissue and light and improves visual contrast. This new technology allows doctors to detect smaller lesions and more accurately diagnose diseases of the upper and lower gastrointestinal tract, including colorectal cancer. In some cases, it can shorten procedure times.

 

Our Lady of the Lake Regional Medical Center

Our Lady of the Lake Regional Medical Center recently gained the distinction of achieving stage six of the HIMSS Analytics Electronic Medical Record Adoption Model. Attained by just .3 percent of hospitals nationwide, stage six indicates that the facility has implemented all of the major EMR components used by physicians, nurses, and caretakers to order, document, interpret, and manage care delivery. Implementing this technology results in higher levels of patient safety and improved quality outcomes. Stage seven is the highest level awarded by HIMSS Analytics and no U.S. hospital has achieved this level.

As part of its journey to Stage Six, OLOL has implemented computerized practitioner order entry (CPOE), electronic physician documentation, and closed loop medication administration, which combines CPOE, pharmacy, nursing documentation, and the bar coding of the patients and medications to prevent medication errors.

OLOL's Chief Medical Information Officer, Dr. Paul Murphree indicated that OLOL has actually been using a partial form of electronic health records for many years, but it was in 1999 when the hospital teamed with a company called Cerner that it moved to the forefront of Health Information Technology (HIT). The company started off with a basic program and allowed OLOL to customize and grow the system and data to fit its particular needs. For a while, the hospital even operated as an “alpha site” where new manifestations were implemented on a trial basis to test, improve, and demonstrate them to other entities. Although this allowed OLOL to have access to state-of-the-art systems before anyone else, the hospital has since relinquished its alpha status to allow itself more flexibility to fit the program to the facility. The hospital remains the flagship of the Franciscan Missionaries of Our Lady (FMOL) health system in terms of HIT.

As the hospital continues to fine tune the system, Murphree admits there is a learning curve and that some practitioners have to be convinced of its benefits before they will jump on board. About 25 percent of the physicians practicing at OLOL currently use the system, but more are coming online every day. For the initial phases, the hospital targeted the high users, the doctors that are practicing at the hospital every day. Dr. Murphree has made increasing doctors' comfort levels and encouraging them to use CPOE his personal mission, constantly pointing out to the doctors the system's benefits, such as: instant feedback on your order entry or progress notes; Tallman lettering which emphasizes the differences in similar words, particularly drug names, eliminating the guesswork and errors associated with physician handwriting; and built-in order sets, reminders, and alerts. This was an area on which the hospital worked extensively with Cerner. “You can build in alerts for just about anything,” said Murphree, “But you don't want to have so many, that they are meaningless. We opted for the most vital notifications, such as a full page warning when ordering a medication that is contraindicated with previously ordered treatments, a pop-up allergy notification, an offer to review lab results when ordering any medications, etc.” The alerts are also constructed so that they can be overridden by the physician. “We never want to have a computer make a clinical decision,” said Murphree, “but it helps to have the resources and reminders right there on the screen. The computer does its job of letting you know there is a potential problem, and then the physician can use his/her experience and judgment to decide how to proceed.” OLOL also built in alerts and reminders related to the Five Million Lives initiative, a national campaign to dramatically reduce incidents of medical harm in U.S. hospitals. That way the electronic system helps implement and track quality of care tasks throughout the hospital. As opposed to desensitizing caretakers with alert overkill, the system will generate lists of treatment recommendations to ensure the best patient care.

Because the doctors, nurses, labs, pharmacy, etc. are all on the same system, it is easy to enter and check progress notes, file and check lab results, order and administer medication, even research a condition and access treatment recommendations–all from the computer. Not only does this ensure that everyone is on the same page, but it allows everyone involved in patient care to track what has been done. Doctors can even access the system from outside of the hospital so they can check on a patient's progress. A built-in messaging system, similar to e-mail, allows instantaneous communication with others involved in a patient's care.

The system also allows for closed loop medication administration. Medications can be ordered from the pharmacy online, and as mentioned before, the computer will notify the doctor of any contraindications. The pharmacist can also review this information and make suggestions. There are no handwriting issues because everything is entered electronically, with the additional security measure of Tallman lettering. The pharmacy will send up the correct dosage bar-coded exclusively for that patient. If the patient's barcode on their wristband and the barcode on the medication don't match, an alert will pop up on the hand held scanner used by the nurses. Murphree said some patients grumble that they are being scanned like an item at  the checkout counter of Walmart, but once they realize it is for their protection, they approve. One of the features that is impressive about the closed loop system is that a doctor can impose an immediate stop on a medication, even if it has already been dispensed, bar-coded, and has made its way to the patient floor. As long as he enters that stop on his computer, before the nurse scans the patient, the system will not allow the nurse to continue. In the near future this closed loop of medication administration system will include a robot to mix medications and apply barcodes.

The electronic system also includes order sets for several diseases and conditions commonly treated in the hospital. These are guidelines and a standard of care agreed upon among the physicians in a particular service area. So, if a patient presents with pneumonia for example, the physician can access that order set and it will outline the treatment steps, available medications, precautions, reminders, etc. to provide an agreed upon standard of care. “The most amazing thing,” joked Murphree “is that we actually got doctors to agree.” Actually they have collaborated on about 300-400 order sets.

Although the hospital has kept electronic records for quite some time, new information entered on the current system enters every piece of information as a discrete entity. This allows for tracking and graphing by just about any variable and will improve efficiency and performance. (Information that is still currently recorded on paper will be entered into the system through scanning, but does not have the advantage of being broken into discrete data.) This will also apply system-wide as the technology is implemented at each of the family of Franciscan Missionaries of Our Lady (FMOL) facilities and they gain the ability to share more and more data, such as patient histories between them. Estimates are that 40 percent of the Louisiana population seek treatment at one of the FMOL hospitals, so this ability to share information will improve patient care for a large portion of the state.

OLOL is currently exploring the possibility of creating a patient portal, where patients can access some aspects of their record themselves. Currently the information is accessible through physicians' computers, computers at nurse's stations, the hand-held scanners, and the workstations on wheels or WOWs that can travel between patient rooms. The system also includes an online medical reference site called Up To Date, as well as access to Google, which studies have proven useful for searching symptoms and studies for making diagnoses, said Murphree.

 

Baton Rouge General

Like many hospitals, Baton Rouge General's first experiences with information technology were piecemeal. As technology became available they might automate a system here, add an electronic version of a system there. And like many hospitals, they discovered that while each “latest, greatest” technology did improve efficiency, they didn't always work together. So, when the General decided its goal was a seamless, paperless, electronic approach to all systems, it sought out one vendor, McKesson, who could do it all, and in a limited timeframe of just two years. About the third of the way into full implementation now, the hospital will eventually have approximately 35 fully automated components which can “talk” back and forth, are accessible by all players in the treatment plan, include remote access by physicians, and seamlessly link the Bluebonnet and Mid-City campuses.

Some of the most important components of this system are already up and running, such as the Electronic Medical Record, the Medication Safety Program, and the Emergency Department Tracking Board. The Medication Safety Program is a completely automated system that follows the patient from admission through the hospital stay and back to their primary care physician. It tracks the medications they are on, allergies, medications they receive during their stay, and other patient information. The system provides administration safety checks and alerts for allergies and contraindications. In the pharmacy, medication is dispensed by a robot that follows the instructions in the electronic prescriptions ordered by the doctor. Not only does the robot increase efficiency and reduce errors, but it allows those who work in the pharmacy to spend more time in patient consultation to customize treatment.

In addition, the General recently launched its electronic Emergency Department Tracking Board, which replaces the traditional white board with a real-time way of tracking who's waiting, who's being treated for what, and by whom. In addition to the basic tracking information which appears on large plasma screens in the ED, the information is also accessible at desktop stations in the department and elsewhere in the hospital. The board includes triggers to other departments if their services are needed, such as a lab test or a consult. It even notifies housekeeping if an area needs cleaning. In addition it allows a quick view of what types of cases are waiting, and allows the staff to forecast what they will need in terms of treatment and admissions. Not only is efficiency improved, but it means a shorter timeframe for the patients that present in the ED. Even after just two weeks of use, the doctors and nurses had submitted their own ideas of how to customize the system to their ED and the vendor was making those adjustments.

One part of the hospital in particular has been a kind of pilot for the automated information technology at the General. The Pennington Cancer Center is already operating in a completely electronic, chartless, paperless mode. When the plan was first developed to build the Center, the staff wanted to be able to communicate patient and treatment information effectively between campuses and between the physicians. They decided a chartless and paperless format would be the most efficient and secure. In addition, they wanted to integrate that information system with their treatment systems, which were already on the cutting edge of technology. The mindset was basically the same as the hospital as a whole, but in a smaller, more controllable environment, so it was easier to implement. The Pennington Cancer Center is now the only chartless, paperless radiation oncology center in the region and the General is taking some of its cues from the Cancer Center as it implements its system-wide information technology.

The Cancer Center also applies the same innovative approach to its treatment technologies. The Center uses a linear accelerator, more affectionately known as LINAC, to deliver therapeutic levels of radiation very precisely to kill cancer cells with minimal collateral damage to healthy tissue. The technology has continuously developed to improve precision, accuracy, treatment delivery, and versatility, allowing treatment in a greater number of areas of the body. Alongside of this has developed a cutting edge imaging system that allows accurate views up to within a minute of treatment delivery to be sure the radiation is delivered as precisely as possible.

Zach Smith, Director of Radiation Oncology at the General's Pennington Cancer Center compared the evolution of this treatment technology to the constant evolution in car manufacturing. “Think back to ten years ago and then consider all of the style, safety, engineering features that are offered on cars now,” said Smith. “Our technology is similar in terms of the leaps and bounds we have made in cancer treatment. Like the car manufacturers who are constantly working on the features of next year's model, we are also working on the next generation of this technology.” The Center, which is a current flagship for top-of-the-line radiation therapy, has partnered with Siemens, the creator of the current technology, to develop the next generation. Not only will it be even more precise, but it will offer almost live imaging at times of treatment delivery for the most precise treatment possible. When this technology is ready, the Pennington Cancer Center will be the first facility in the United States, and one of only three in the world, to have it.

Smith said that Siemens is committed to its technology being accessible by everyone and is excited about making it available and practical for a community cancer treatment center rather than the usual academic centers, which tend to have more resources and fewer patients. “It makes sense,” said Smith, “because 85 percent of cancer patients receive treatment in community cancer programs like ours.” In order to sell this very expensive equipment, which costs $2-3 million, it has to be able to be used successfully in the community programs where the patients are. Siemens has declared Pennington one of its Centers for Excellence, and visitors often contact or visit the facility to learn about cancer treatment technology.

The Cancer Center is also fielding inquiries about its state-of-the-art computerized portal imaging technology. Smith recently was invited to the University of Texas M.D. Anderson Cancer Center to share his knowledge and experience about this highly advanced technology, which is based on a digital computerized radiograph (CR) platform and helps doctors to confirm that radiation treatment is accurately aimed at a cancer patient's tumor. 

To replace their current imaging technology that is nearly 8 years old, M.D. Anderson is now looking at the CR technology Pennington Cancer Center has been taking advantage of for more than a year. Because of his first-hand experience with the solution and his clinical expertise in radiation oncology, Smith was invited to advise M.D. Anderson's physics team about the implementation, interfacing, and workflow processes used in deploying this premier technology.

Due to its superior image clarity, ability to be securely and remotely accessed by multiple users, durability, and unique design specific to oncology, Fuji-film's new Radiotherapy Portal Imaging technology continues the field's evolution to the new digital platform standard. In 2006, Pennington Cancer Center partnered with Fuji-film, a leader in imaging technology, to become the sole U.S. testing site for its latest CR Cassette for Portal Imaging solution. During the 15-month clinical trial, Pennington Cancer Center's radiation team looked at clinical workflow processes and day-to-day use while imaging 564 patients during their treatment course. “When we initially partnered with Fuji-film Medical Systems last year, it was because we were looking to upgrade our imaging technology and we knew we wanted the latest, most innovative solution for our patients,” Smith explained. “Because of our work at Pennington Cancer Center, other top cancer centers around the world will be able to utilize this amazing technology to benefit their patients.” 

Smith said part of the drive to implement the very latest and greatest technology is the feeling that as the capital city, Baton Rouge should start to be able to offer this level of treatment to its people right in their backyard. “Cancer treatment is tough enough without having to travel out of state to get it. We think it should be available here.”

 

Lane Regional Medical Center

Lane Regional Medical Center reports that it has a lot of new technology recently implemented or in the works. The big picture includes a multi-million dollar commitment to converting from analog to digital equipment throughout the organization, as part of Lane's broader commitment to electronic medical records and bedside charting. The system will include Electronic Medication Administration Record (E-MAR), Document Scanning, Mobile Carts for bedside charting, Status Board and Flow Sheet for Nursing, Bedside Medication Verification, a Physician Care Manager including Physician Order Entry, and wireless infrastructure for patients and visitors. The hospital is also in the process of building a new state-of-the-art cath lab as part of its recently launched Cardiology Services, which will offer world-class physicians and care in the heart (no pun intended) of Zachary. And, construction is underway on Lane's fourth medical office complex, which will be the first 3-story building in Zachary.