Andrea Sattinger is a regular contributor to The Hospitalist.
References
- Arnst C. The best medical care in the U.S.: How Veterans Affairs transformed itself—and what it means for the rest of us. BusinessWeek online. July 17, 2006. Available at www.businessweek.com/magazine/content/06_29/b3993061.htm?chan=top+news_top+news. Last accessed October 20, 2006.
- Kaboli PJ, Barrett T, Vazirani S, et al. Growth of hospitalists in the Veterans Administration (VA) healthcare system: 1997-2005. Hosp Med. Abstract. 2006;1(S2):1-30.
- Lurie JD, Merrens EJ, Lee J, et al. An approach to hospital quality improvement. Med Clin North Am. 2002 Jul;86(4):825-845.
A Hospitalist Revolutionizes UCSD’s Online Clinical Systems
Dr. Lee combines his background as a physician and interest in technology in his job developing patient-care computer systems at the UCSD Medical Center.
Josh Lee, MD, is a hospitalist. But Dr. Lee is also a computer geek, and the combination has served him and patient care well.
As medical director of Information Services at the University of California at San Diego (UCSD), Dr. Lee has oversight over all online clinical systems, and that is no small task. With Dr. Lee’s guidance, UCSD is now a leader in the medical informatics movement. With the exception of physician documentation, the system has comprehensive electronic records; that is, some physicians still prefer to “wet-sign” their notes. Lab results at UCSD are 100% electronic, as is order entry for adult inpatients. “We have now completed what we call the entire order life cycle: physician orders, direct integrations through our pharmacy, pharmacy validation, and bar-coded administration at bedside,” he says.
As opposed to the VA’s homegrown EHR, UCSD did what many healthcare systems do: They bought an off-the-shelf product—this one was Invision from Siemens—but UCSD calls their product PCIS, for Patient Care Information Services.
“A lot of people are able to do cool stuff [with medical informatics],” says Dr. Lee, “but they have done it with a proprietary product, so it’s different than VA, where they are using something they have total control over.”
He says many people are now focused on order entry, “but I think the newest area of research and integration [involves the question], how do we communicate key clinical issues and follow-up for discharge?” (See Figure 1, above.) At UCSD Medical Center, these screens can be printed and the pages given directly to the patient upon discharge.) “We have leveraged our electronic system to ensure that, at the moment of discharge, not only is the patient informed about [his or her] care, but it is clear to anybody on our side, or from the side of the receiving physician, what is supposed to happen next.”
As any hospitalist knows, there can be a huge “voltage drop” in this area, as Robert Wachter, MD, professor and associate chairman at UCSF’s Department of Medicine, San Francisco, refers to it. Dr. Wachter is
And the great advantages of the VA’s electronic products are not available to the “99% of American hospitalists who don’t practice in closed systems,” says Dr. Lee.
Because most hospitalists don’t have that advantage, careful and complete discharge communications are imperative. That’s why UCSD built screens that can accommodate the specific information patients need, he says. “It’s different from the classic discharge summary, which is usually a lengthy, unwieldy, dictated document that is mostly [composed] after the patient leaves the hospital. This is done in real time … and these print-outs are immediately available for the patient.”
Before Dr. Lee came to UCSD, he worked with Drs. Jon Lurie, Mark Splaine, and Ed Merrens, all members of the general internal medicine division at Dartmouth-Hitchcock Medical Center in Hanover, N.H.3 As part of the team’s exploration of quality improvement and medical informatics, they particularly looked at how to adapt products to be workflow sensitive.