Putting PCs in the O.R.

[NRSKarenRN, BSN, RN]

Tuesday, 06/25/02

The Tennessean

By BILL LEWIS

Staff Writer

http://www.tennessean.com/business/archives/02/06/19166911.shtml?Element_ID=19166911

Personal computers, a common sight in offices and homes, have made their way into the operating rooms of St. Thomas Hospital.

The hospital is taking ordinary Dell PCs into its operating rooms where, loaded with a specialized program created by a growing East Tennessee company and customized at the hospital, they are being used to meet the twin goals of improving patient safety and controlling costs.

The flat-screen PCs are mounted on IV poles next to the operating table. Nurses can use them to predict and record everything from procedures performed by the surgery team to the amount of supplies used.

''We refer to it as a computer on a stick,'' said Jim Toole, the registered nurse in charge of the program that brought the computers into the operating rooms.

''It standardizes what we do in surgery,'' he added.

The computers have already cut down on what is known at the hospital as ''riding.''

Previously, anything that might be needed in a particular surgery was ordered from the downstairs supply room. Supplies that weren't used were sent back down on the elevator. Because there are 3,600 different surgical supplies to choose from, that meant more work for the staff and more potential for billing confusion.

''We call it riding up and down,'' Toole said. ''We're coming to the point where we're able to see what it really costs'' to perform an individual surgery.

''There was a time when it was free rein,'' Toole added. But managed care and other pressures to control costs have changed that.

''It's a business. Our business is taking care of people, but it has to run like a business,'' Toole said.

The operating room computers use specialized software, called CareMap, to prechart everything that is expected to take place during a surgery-from the drugs used to the position of the patient on the operating table.

The idea is that nurses will be freed from having to record routine procedures on paper charts. That should leave more time to care for the patient.

Registered nurse Rhonda Scott, a member of the team that spent 18 months customizing CareMap for St. Thomas, said the computer program even tells nurses what radio station a particular surgeon likes to listen to.

Because CareMap replaces the traditional paper charts that keep track of a patient's progress, the team even prepared for an unwelcome but inevitable event-the computer crash.

Each CareMap PC is backed up by independent server computers, ''not just one, but two that mirror each other,'' Scott said.

The PCs also have their own backup power supply.

''It's been unplugged during charting,'' Scott said.

''And,'' chimed in team member Jane Callahan, ''it keeps on going.''

The software being used by St. Thomas was developed by a company named iPath.

The Knoxville-area company was recently purchased by GE Medical Systems, part of General Electric Co. GE anticipates that the market for such paperless operating room information systems will reach $250 million by 2005.

More than 240 hospitals use the company's software, but St. Thomas has taken it a step further by using it to manage patient care, said iPath Vice President Mark Mabry.

''Most are using it just to manage the business of the operating room. The scheduling, the ordering,'' he said.

St. Thomas found iPath's software flexible enough to help manage patient care. Other hospitals have tried to use less-flexible software in a clinical setting with less than successful results.

''If you're carrying around computers that don't have the right software, it's a burden,'' said Carol Bickford, senior policy fellow for the American Nurses Association and a registered nurse. ''There's a lot of data going into those systems, and it becomes a data cemetery.''

On the other hand, hospitals that use technology to support the mission of their nurses-as St. Thomas hopes to do with CareMap-are finding that their staffs are supportive.

''If the staff was involved in decision making, so it truly reflected their work flow, they probably would accept it,'' Bickford said.

That's what Toole thinks St. Thomas has accomplished.

''We went to the people who actually see the document,'' he said. ''We built this thing from scratch.''

Bill Lewis covers the business of health care. He can be reached at 259-8075 or at [email protected].