Tech savvy

By most measures Orange County's biggest hospitals are leaders on the technology front.

Hoag Memorial Hospital Presbyterian, the University of California Medical Center and the St. Joseph Hospital have all spent a lot of money on high-tech medical devices and Internet-based data storage and communications systems.

Add to that list the Memorial Health Services chain of hospitals. Memorial was recently named for the third straight -year as one of the "100 Most Wired" hospitals by the American Hospital Association's Hospitals and Health Networks trade magazine.

Long Beach-based Memorial Health Services is a nonprofit with three hospitals in the county: Anaheim Memorial Medical Center, Orange Coast Memorial Medical Center in Fountain Valley and Saddleback Memorial Medical Center in Laguna Hills.

The 100 Most Wired survey looks at how hospitals and health systems use information systems. It also examines the digital divide between the most-wired hospitals and least-wired ones.

While Memorial was the only hospital system with OC operations that made the list, other area hospitals aren't lagging.

Wireless networks are gaining acceptance, along with systems that allow easier access to medical records and electronic pharmaceutical prescription ordering.

"Information technology itself is not a strategy-it's an enabler," said Annette Walker, Memorial's senior vice president of strategy and physician integration. "In our business, technology is a significant enabler."

Walker is a member of the Most Wired editorial board, which does not vote on the list.

Memorial uses surveys such as 100 Most Wired for benchmark purposes, Walker said. Surveys can direct Memorial officials in developing their technology goals.

The survey found that Web-based prescription renewals, scheduling appointments, specialist referrals and disease management are on the rise at U.S. hospitals.

More than 90% of the hospital groups on the list provided online management for diseases such as asthma, cancer, diabetes and heart disease.

And the study found that there is a big gap between technology use at the most-wired hospitals and less-wired ones.

Access to current medical records through the Web or other technology exists at 81 % of the most-wired hospitals, compared to 40% of less-wired hospitals. Eighty-two percent of the most-wired hospitals allowed doctors and nurses to view laboratory results via technology, while 45% of less-wired ones did.

When it comes to patient-related technology, 80% of most-wired hospitals provided Web-based physician referral services, compared to 48% of less-wired hospitals.

And 28% of the most-wired hospitals have Web-based prescription-renewal services, while 6% of other hospitals offered the service.

Memorial's technology initiatives include a project called "Palm Doc," which provides physicians at its hospitals with Internet-based Palm Pilot-style portable computing devices.

Among other things, Walker said, Palm Doc devices contain the system's "best practice" clinical guidelines.

"No matter where physicians are, they're going to touch a button and the best practice guidelines are available to them," she said.

Palm Does have patient census numbers and staff rosters and physicians can code a procedure into a patient's medical record. Long term, physician prescription entry is a goal.

Palm Doc, which originated at Anaheim Memorial, grew out of a project that was designed to get the hospital's drug list, or formulary, into doctors' hands.

The hospital chain was concerned about how it could add additional safeguards to assist physicians in their prescribing.

"There's a high sensitivity of errors in the drug area," Walker said.

Prescription-related errors gained a lot of attention last year, when the federal Institute of Medicine issued a report detailing how such problems affected healthcare delivery.

Memorial has rolled out Palm Doc to its three local facilities and to its Long Beach Memorial Medical Center. About 120 doctors now use the devices.

Memorial's Saddleback hospital has installed a wireless network that allows communications while moving within the hospital. It contains the hospital's information system.

On the patient side, Memorial introduced the MemorialCare medical information and access card program. Officials claim the program has more than 500,000 members and 550 participating physicians. Some medical information is available through the Internet, via a PIN number. And there is myelectronicMD, a health-screening tool that gives patients and doctors possible diagnosis lists, relevant medical tests and types of doctors to consult through the program.

Walker said that MemorialCare members use the program in non-healthcare environments-filling out their children's school forms, for instance.

Santa Barbara-based Tenet Healthcare Corp., OC's largest hospital operator with 10 local facilities, has its own technology initiatives under way.

Tenet installed a wireless telephone system that allows doctors, nurses and other hospital staff members to communicate without interfering'with medical equipment. Traditional cellular phones are often banned in hospitals because their signals could shut down equipment such as ventilators and heart monitors.

And Tenet hospitals have launched Web sites that let patients see information about doctors within its network. The sites have health information exclusive to a hospital's network, in multiple languages, as well as a database that provides medication information, such as drug interaction and allergy warnings. Tenet's Web sites are expected to let patients pre-register for surgical procedures and register and pay for hospital classes and events online.

Newport Beach's Hoag Memorial Hospital Presbyterian has an electronic medical records system through a password-protected Intranet.

"We have computerized multiple pieces of patient documents," said Steven Moreau, Hoag's chief operating officer. "It's a wonderful medical tool for providing instant, updated information."

Moreau wouldn't say how much the hospital has spent on technology.

"I couldn't hazard a guess-it's in the tens of millions," he said.

The hospital has invested at least $15 million between its electronic medical records system and the patient archiving and retrieval system that is used in connection with imaging services, such as X-rays, CT-computed tomography-scans and magnetic resonance imaging, along with cardiology services, Moreau said.

In addition to providing top care, Moreau said competition enters into technology investment planning.

Moreau said Hoag will break any resistance among its 800 physicians, some of whom are reluctant to use information technology.

"Within the year, we will require 100% of physicians to use (computerized) physician order entry," he said. "They will have to use the computer."

Up the road at UCI Medical Center in Orange, the best use of information technology is probably its clinical database, according to Joy Grosser, UCI Medical's chief information officer.

Laboratory results, doctors' dictation and nursing notes are stored in a central database that can be accessed both in the hospital and in clinic settings.

UCI doesn't plan to use Palm-style devices for prescription order entry because it's complicated to load different health plans' drug lists into the devices, Grosser said. Instead, she said the main computer will store prescription information.

Grosser believes a hospital should consider whether a new technology would make a patient's stay easier, and whether it would improve a hospital's quality of care, research or education when choosing to adapt it.

"As opposed to (an approach) like I went to the mall and saw this new cell phone," she said. "Technology enables us. It's not the driver."

To come up with the 100 Most Wired hospitals, a number of groups in addition to Hospitals and Health Networks magazine are involved in the hospital polling. They include San Francisco-based McKesson Corp., Denver-based Qwest Communications International Inc. and the nonprofit Chicagobased Healthcare Information and Management Systems Society.

The survey relies on detailed questions about how hospitals and health systems use the Internet to connect various constituents. Patients, doctors and nurses, workers, suppliers and insurers are among the groups polled.

There were about 300 respondents representing 800 hospitals.