Doctors Making Transition Into Paperless World

By LAURENCE DARMIENTO
Staff Reporter

Doctors, nurses and other staff members at Childrens Hospital Los Angeles did everything they could late last year to crash the facility's $60 million computer system, now under development.

It worked.

While there was no wide-scale failure as they furiously tapped in prescriptions and called up lab results, the computer "slowed down to a snail's pace," acknowledged Mary Dee Hacker, vice president of patient care services. "It didn't go well."

The diagnosis? The complex system needed 95 "tuning corrections," the latest in a series of difficulties that have pushed back the start date for the system, now set to debut in March.

It's a small but telling example of the challenges faced by hospitals turning to new technology as part of their massive makeover projects. Across the region, hospitals are taking steps toward "paperless" medical record systems that will eventually make the traditional hospital chart a relic. It's a road fraught with difficulty.

"This is a major transition," said Dr. James S. Miser, chief executive officer of City of Hope National Medical Center. "People like paper."

Childrens Hospital has decided to develop the system first and then move it to its new hospital, scheduled for completion in four years. Once the system is up and running, it is expected to be one of the most sophisticated anywhere.

"This is a really important undertaking for Childrens Hospital," said John Patterson, the hospital's chief information officer, who adds that his colleagues at other pediatric hospitals tell him, "We are watching you."

Each patient's medical record essentially will be a computer file readily available to authorized users throughout the facility, both through land lines and wireless devices such as tablets and personal data assistants.

Doctors will write up notes on their tablets and be able to instantaneously view lab results and diagnostic images. They also will order tests and drugs via the system.

The hazards inherent in such a massive transition can be seen at Cedars-Sinai Medical Center, which has been ranked one of the 100 most "wired" hospitals in the country. But last year Cedars was forced to pull the plug on its new physician order entry system the part that manages orders for prescription drugs, tests and other services and that is among the most complex.

Physicians at the hospital rebelled against the system, complaining that it took minutes to write prescriptions that had previously taken seconds. In addition, the Los Angeles Times reported that the system incorrectly processed some orders.

Dr. Sajjad Yacoob, a general pediatrician who is also Childrens Hospitals' director of medical informatics, said he doesn't expect a similar rebellion given that doctors, nurses and other users have helped develop the system over the past two years. "There has been significant involvement," he said.

Another advantage: many doctors at Childrens have offices at the hospital where they will be hooked into the system daily, unlike at Cedars where the doctors generally practice elsewhere.

Yacoob acknowledges that older doctors are less comfortable with the new technology and there can be frustration over the time it takes to input a prescription compared to merely scribbling one. But while it might take longer up front to write a prescription, he said there is time to be saved, not to mention improved accuracy.

"If you look at what happens when you scribble, a lot of times the pharmacist has to call back later to interpret it. What they think takes five seconds actually takes three minutes," he said.

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