Computerized Records Help UNC Health Care Doctors Treat PatientsComputerized Records Help UNC Health Care Doctors Treat Patients

It's estimated that fewer than a quarter of hospitals and health care providers in the United States have deployed electronic medical records and other digitized clinical systems for their inpatient settings. Even fewer physician practices, clinics, and other outpatient care providers have made the leap to digitized clinical systems.

University of North Carolina Health Care System fits into a small sliver of health care providers: It has deployed a Web-based interoperable health record system that lets 7,000 caregivers across hospital inpatient units and dozens of outpatient clinics and other settings access medical data for more than 1 million patient visits annually.

Via the Web and using a secure single sign-on, UNC Health Care's 2,000 physicians can access from their homes and offices patient data including lab reports, medical imaging, scheduling, disease prevention applications, and patients' hospital progress notes.

UNC Health Care developed its WebClinical Information System with IBM. The system provides a foundation that lets UNC Health Care caregivers access clinical data from many disparate systems. UNC Health Care and IBM have been working together since 1999 as the health care provider has deployed various electronic clinical applications. But UNC Health Care's move 18 months ago to the IBM Health Information Framework--a standards-based service-oriented architecture--allows its caregivers to access new resources for information and decision-support tools, says UNC Health Care CIO J.P. Kichak.

"SOA in the electronic medical record allows doctors to launch into other Web-based services, like accessing our medical imaging and document imaging systems," Kichak says. That means a physician can view an x-ray report or an image that resides in another system without leaving a patient's electronic medical record.

The IBM SOA integrates and synchronizes UNC Health Care patient information from all care areas and allows that information to be accessed via multiple devices, including PDAs and smart phones.

"SOA provides a flexible infrastructure for health delivery networks to build something today and have new stuff included later," says Mike Svinte, VP of global innovation and information-based medicine for IBM Healthcare and Life Sciences Industry practice. This is particularly important because many medical research centers are looking for new opportunities to analyze and mine data, such as genomic information, he says.

In fact, among upcoming projects being eyed by UNC Health Care is building an enterprise data warehouse for research. Each year, UNC Health Care processes 34 million lab results. It has been collecting that data for the last 15 years in a DB2 repository. By mining that data, UNC researchers could identify new correlations and discoveries.

That sort of clinical data mining, data analysis, and pattern-recognition work is already under way in several projects at other IBM health care customers, including the University of Pittsburgh Medical Center, Mayo Clinic, and Cleveland Clinic.

In the shorter term, UNC Health Care plans to provide doctors and nurses with electronic tools to help avoid patient medication mishaps, a new addition to its WebClinical Information System slated for July.

By accessing drug data from several systems, caregivers will be able to synchronize the drugs a patient is prescribed upon discharge from a UNC hospital with drugs the patient may have been taking at home prior to hospitalization. This coordination can help prevent patients from becoming overmedicated, as well as ensure that necessary medicines aren't omitted from the patient's discharge instructions.

"Order-entry data gets coordinated with discharge data," and doctors are alerted if there's a potential problem, says Dr. Robert Berger, UNC Health Care's director of medical informatics and a professor of medicine at UNC.

Improved patient safety and cost savings have been key benefits since UNC Health Care deployed its electronic clinical systems. Electronic physician drug-ordering for inpatients has decreased potential drug errors by 70%, Berger estimates. Meanwhile, a transition away from written notes and dictation to online physician notes and voice-recognition applications has saved the provider about $4.5 million over the last two-and-a-half years, he says.