Pittsburgh's New Children's Hospital is a pioneer in paperless

Wall-mounted flat-screen monitors glow in intensive care units, graphically representing each patient's blood pressure, medications, breathing, pulse and other vitals. Nurses control computers on wheeled carts, recording patients' symptoms in a database. With a bar-code scanner, similar to a grocery store clerk's, they match a code on each patient's wristband to their medication. Doctors type up prescriptions on laptops and electronically send requests to the pharmacy, through a system that cross-checks for allergies and correct dosages. This is the paperless Children's Hospital of Pittsburgh.
"We built the hospital architecturally without any chart racks or spaces for charts to be," said Children's Chief Information Officer Jacqueline Dailey. "And we built a very small medical records department because we do not intend to move any paper records to the new campus. It's a completely digital hospital."
A review commissioned by the U.S. Department of Health and Human Services found that adopting information technology improved the likelihood that doctors would remember to vaccinate at-risk patients by as much as 33 percent, cut problems associated with medications by at least half and reduced by 65 percent the time it takes to identify a hospital-acquired infection. Wait times for everything from getting X-rays to medication pickup fell by 24 to 73 percent.
For more than 100 years, if a Children's doctor needed a patient's history of care at the hospital, he or she consulted a paper chart -- a file that is supposed to contain all information about past visits, allergies and medical conditions. But Children's has many departments, and it takes time to move a file from Allergy and Immunology at the main hospital in Oakland to Dermatology in a satellite office in Pine.
In 2003, when Children's broke ground in Lawrenceville, it took its first step toward adopting computers as a replacement for paper-pushing. Physicians surrendered prescription pads and learned to enter orders into a computer system created by Cerner Corp., a health care information technology firm in Kansas City. The computer alerts doctors if they mistype the dosage, overlook an allergy or prescribe a medicine that would interact adversely with another. The order is transmitted electronically to the Children's pharmacy. The pharmacist is alerted to any possible problems.
Potential medication errors dropped from nearly 1 in 10,000 in 2003 to less than half that last year, when the process was finalized by giving nurses the bar-code scanners.
Medical equipment, from IV pumps to wheelchairs, has digital tags that the hospital's campus-wide wireless network can detect, allowing nurses to locate them. The 4,000 desktop computers, plus laptops and hundreds of computers on wheeled carts, connect to the network. MRIs, X-rays and other diagnostic tests once put on film are digital and accompany a patient's e-record.
Six operating rooms, three times the number in Oakland, are designed to facilitate minimally invasive surgery. These rooms are filled with flat-screen monitors that guide surgeons with images endoscopic cameras pick up. Computers record surgeries, which doctors can play back.
Children's and Vanderbilt Medical Center's Monroe Carrell Jr. Children's Hospital are the two children's hospitals to earn a "stage 6" rating from the Healthcare Information and Management System Society, a nonprofit that ranks hospitals based on how close they are to achieving true electronic medical records, called "stage 7."

Source: Pittsburgh Tribune Review, April 5, 2009