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For Hospitals, an Inevitable Path Towards an All-Digital Future

By Dan Orzech

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Slowly -- but inexorably -- the health care industry has been moving towards a world where patients' records are stored completely digitally. First to go online at most hospitals have been the doctor's notes, prescriptions, and other written records. The enormous, bandwidth-hogging digital files that x-rays and other images require, however, have posed more of a challenge.

New imaging technology emerging out of one of the largest non-profit integrated healthcare systems in the country, the University of Pittsburgh Medical Center (UPMC), however, now promises to speed up the process of digitizing images from x-rays, CT scans and MRIs.

UPMC has created a completely "filmless," all-digital system for handling x-ray and other medical images. The hospital system does more than 1 million exams requiring medical images each year.

Called iSite, the imaging system was the brainchild of Dr. Paul Chang, a UPMC radiologist, and has been commercialized by a San Francisco-based company called Stentor.

With iSite, doctors at UPMC no longer need to order xrays films from storage the day before a patient is scheduled to be seen. Instead, they can now instantly call up the x-rays from any desktop computer at ten of the hospitals in the UPMC system.

That improves patient care, says Dan Drawbaugh, UPMC's CIO. Doctors can look at all of a patient's images, comparing current x-rays, for example, with ones taken a year ago.

Putting medical images online also removes the need for expensive courier services to shuttle x-rays, or -- as sometimes happens when doctors are pressed -- patients themselves carrying x-rays between doctor's offices.

It also cuts radiology costs, which have been climbing steadily, and now represent about six percent of health care costs nationwide, according to Drawbaugh.

Medical orphans: Xrays
While larger numbers of medical facilities have written patient records online, only about 10% of hospitals today have digital image systems, which the industry refers to as PACS, for Picture Archive and Communication Systems, says Drawbaugh.

That can make things awkward for doctors, according to Guy Creese, research director at the Aberdeen Group. "As more and more written medical information has gone online," he says, "x-rays, CAT scans and other digital images have become "orphans" of sorts. If I go to my doctor, and he has my medical records online, but not my x-rays, he has to flip back and forth between reading my history online and looking at the physical xrays."

Advances in technology are now making it easier to put medical images online. "One of the things that makes this possible now is the plummeting price of disk drives," says Creese. "Ten years ago, you would have had the recent images on disk, but older ones would have been on optical drives, because it was cost prohibitive to do anything else. But now it's not."

Now, says Creese, the commodity in high demand is bandwidth, rather than storage. One of the keys to the Stentor system, he says, is that UPMC "has figured out compression algorithms that make it not as onerous to move images around."

Keeping costs down -- and reducing mistakes
For the health care industry, these technology advances are arriving just in time. A number of forces -- including the federal government -- are pushing hard to digitize medical records. The Health Insurance Portability and Accountability Act of 1996, or HIPPA, spelled out requirements for protecting the confidentiality of patient records, including being able to establish an audit trail and establish who has had access to a patient's medical history.

Since it's much easier to establish an audit trail electronically, that by itself would probably be sufficient to nudge hospitals and insurance companies towards digital records. But HIPPA goes further, requiring the health care industry to begin exchanging patient information electronically, using national standards such as EDI.

HIPPA is not the only force driving the adoption of digital records in health care, however. "Everyone recognizes that electronic patient records are one way to keep costs down," says Creese. "They also decrease mistakes."

That leads UPMC's Drawbaugh to conclude that PACS will become a pervasive technology within healthcare. "It's inevitable," he says.

The paperless hospital
At one new hospital, the all-digital future that Drawbaugh envisions is already a reality. The Indiana Heart Hospital, a new 88 bed cardiac care center in Indiana that opened its doors just this week, was designed from the start to be an all-digital facility. The hospital has no files, and no medical records department.

The hospital uses an all-digital medical information system from GE Medical Systems called Centricity, which integrates patient information from every care area of the hospital into a single electronic record.

"We're so totally committed to a paperless, filmless and wireless environment that we don't even have nursing stations," says the hospital's CEO, David Veillette. "Instead, all our caregivers can input and retrieve patient information right at the bedside."

The system is expected to reduce medical errors by up to 80 percent, according to the hospital. The Institute of Medicine, part of the National Academy of Sciences, says medical errors cause up to 98,000 deaths in hospitals each year.