Midwest Heart Specialists (MHS), a 32-physician cardiovascular practice in Illinois, has recently implemented a computerized patient record system, called CardioWorks, to enable efficient compilation of clinical data. A unique feature of this system is the ability to perform real time queries of the clinical database in order to present them to the clinician in the form of clinical alerts. The clinical data is obtained by a combination of nursing and physician entry as well as direct laboratory and hospital links. Pre-defined queries, in the form of alerts, are introduced to the clinician at the time of the patient encounter.
These alerts allow for automatic notification of information such as drug-to-drug interactions, drug allergy interactions, calculation of clinical goals according to practice-wide established standards of care, as well as the evaluation of risk factors. Tests and procedures are ordered on-line. Results are traced to ensure that they are available in a timely fashion. Physicians are notified when results appear, and are also able to monitor incomplete or missing test results. The doctors have access to all the underlying clinical information. This includes demographic information, current diagnoses and medications, past medical and family history, vital signs, and the results of tests performed.
A messaging system allows the exchange of patient data to be documented in the medical record as well. All of this data is filtered and presented to the physician in as concise a manner as possible while still allowing to obtain the detail when desired. Underlying this system is a complex technological framework. At the point of care, the nurses and physicians use hand-held computers, which access the information they need via a wireless network connection. The devices are small enough to be easily carried and are easy to use. Each clinical facility, spread out over a large geographic area, is linked to the others over dedicated data lines using Internet-based technology to form a secure and reliable Intranet or wide area network.
Because all of the information entered into the system is stored in a single relational Software Query Language (SQL) database, everything is available to any physician at any location as soon as it is introduced into the system. Backups are in place at every point in the system to insure availability at all times. Physicians can access the system from their homes or any place with a phone line as well. Security and confidentiality of patient information have also been implemented through the use of encrypted passwords, audit trails, and digital signatures. Open technology or commonly available applications have been used whenever possible to allow for growth and flexibility, as well as enable ease of use for the health care provider.
The MHS computerized patient record system has been implemented since January 1st 1998 at four offices. Already MHS has benefited from the use of the system in almost every area of care. Recently a patient with a pacemaker was travelling on business when he had a heart attack. The physicians who were caring for him were very concerned that the heart attack had altered his pacemaker function and were preparing for surgery. A quick call and digitally available chart assured the out-of-state doctors that the pacemaker was working appropriately. A longitudinal patient record where office care is incorporated into hospital care saved the patient an unnecessary operation and allowed better care.
In the area of clinical alerts, Midwest Heart Specialists practice is currently monitoring compliance on certain key benchmarks in cardiology, such as the identification and the modification of risk factors for coronary artery disease. These include smoking cessation, exercise, weight reduction, as well as the treatment of abnormalities of cholesterol. A second area of interest deals with the insurance that treatments and medications which have been shown to be of benefit protect all patients. For example, the use of aspirin in certain heart patients can reduce the risk of future heart attacks by 40%. Data has been gathered on every Midwest Heart Specialists' patient examined with CardioWorks for most of these benchmarks.
The use of the CardioWorks computerized patient record system has had a profoundly beneficial impact on the quality of care for the Midwest Heart Specialists' patients. Decision support in the form of clinical alerts delivered at the point-of-care significantly improves the quality of health care and its delivery. The important component is the ability to offer relevant information to the clinician while the patient is still in the office and, ideally, still in the examining room. The computerized patient record provides a fast, reliable means of access to all patient information anywhere in the system whenever it is needed. Security is much improved over the paper-chart system. Clinical data can be analysed and reported on, not only to establish and disseminate a practice-wide standard of care, but also to assess the outcome of care for all patients on an on-going basis.
In June of 1998 a heart medication was recalled suddenly by the Food and Drug Administration because of a potentially life-threatening interaction. With CardioWorks, MHS physicians were able to identify in minutes which patients were using the medication and notify them. The next step is to move out of the office and into the hospitals where the Midwest Heart Specialists' physicians practice. A link has already been established with the Good Samaritan Hospital to allow physicians in the cardiac catheterization lab access to outpatient information. Similar projects are in planning stages at three other area hospitals. Eventually, CardioWorks will form the bridge between hospital medical information systems and physician office systems to create a "Virtual Heart Hospital".