Military health care planners are constantly discussing how they are building the hospitals of the future.
Despite progress toward the digital hospital of tomorrow, military planners are still grappling with the technical problems of today.
When military health care planners say they are building hospitals of the future, they are referring to implementing state-of-the-art clinical decision support and e-prescribing systems.
Consulting firm PricewaterhouseCoopers described that vision in a recent report. “The digital hospital goes beyond advanced clinical systems and includes significant additional integration between medical and information technologies that have historically been beyond the scope of a hospital’s information technology strategy,” the report states.
The Defense and Veterans Affairs departments are planning to make big improvements.
The VA Medical Center in Orlando, Fla., and the DOD hospital planned for Fort Belvoir, Va., will be built with larger private rooms, family visiting areas, hidden cabling for medical devices, acoustic flooring to absorb noise, and personal wireless devices and Internet connections so patients can keep in touch with loved ones or pass the hours on the Web.
Those features are designed to make a patient’s stay healthier and more pleasant.
Computerized physician order entry systems have long been commonplace at military health facilities, making most VA and DOD hospitals ahead of the civilian health care industry.
“You can’t find a prescription pad in any of our hospitals,” said Robert Foster, program executive officer and deputy chief information officer for operations, support and acquisition at the Military Health System. “This cuts down on errors because physicians’ handwriting is so often illegible. This hasn’t been implemented much in the civilian sector, yet we’ve been doing it for 15 years.”
VA and DOD hospitals also have some pretty sophisticated surgical technology like robotic surgical systems combine with high-resolution video feeds.
Digital Hospitals
But the benefits of such technologies have mostly been felt at the departmental level.
Pharmacy operations have improved; lab testing processes have been automated; the surgical theater is a technical marvel.
Yet the fully digital hospital remains elusive.
That seems no less true today than it was three years ago when PricewaterhouseCoopers studied the issue.
In the firm’s report, analysts painted a portrait of a digital hospital that “comprises a completely automated and deeply integrated set of health information services capabilities that fulfill clinical, financial and administrative requirements. The common elements are core technologies and automated processes.”
Most facilities lack such elements, and even military hospitals have not reached a level of automation that would qualify as digital under that definition.
“A digital hospital cannot be purchased off the shelf,” the report states. “Implementing the digital hospital concept requires the integration of many subsystems. Substantial benefits may not appear until a sufficient level of automation — a tipping point — has been reached.”
Re-engineering health care
Military hospital planners say they recognize that their facilities are not tightly integrated.
They also understand the scope of the effort.
Officials at the Veterans Health Administration are after nothing less than a wholesale re-engineering of VHA’s health system, said Craig Davis, CIO at VA’s Orlando facility.
To do that, the military must solve the perennial problem of exchanging patient data.
VA and DOD struggle to share information at a global level, but problems also crop up within individual hospitals, which frequently treat the same patients.
The first challenge is figuring out how to automatically upload data from radiography, laboratory and other clinical systems into an electronic medical record.
The next challenge is transferring data between the departments’ EMR systems.
“The lack of data standards is an endemic problem,” Foster said. “Health care organizations are having difficulty moving data from one place to another because the data means different things to different systems.
To pull all of that data together, we need to migrate to agreed-upon standards.”
Industry groups have made some progress in pushing for interoperable data standards among clinical systems and EMRs.
Health Level 7, a technical standards organization, is developing sets of standards that systems operating in a service-oriented environment can use to conduct transactions with one another.
The ultimate goal is to improve treatment results, which means the real challenges facing the military hospitals of the future will likely be financial and organizational.
“We must maintain a focus [that] is outcome-driven rather than technology-driven,” Foster said.
Adopting technologies that meet that goal will involve changing workflows and processes. “Staff will need to change the way they work — possibly dropping older systems and adopting specific work processes designed to maximally exploit the capabilities of a given system,” the PricewaterhouseCoopers report states.
That might be easier said than done. “Many of our senior, more experienced clinicians may never have learned how to use a computer,” Foster said.
“If you throw technology at them, it is very challenging for them to adopt. But we can’t leave them behind because their clinical knowledge is extensive.”
The situation could improve as older clinicians retire, but providers must still be persuaded to adopt the available technologies, Foster said.
“It doesn’t do any good to have an automated appointment system if providers are not utilizing it,” he said.
“There is definitely a gap…in the ability of end users to adapt to technology.”
A continued focus on patient outcomes will help, Davis said. “Medical errors cost $25 billion annually,” he said, but the ultimate return on investment in health IT will be improved patient care and safety.