Table of Contents
Faculty Put Human Perspective
into
Electronic Medical Records
School of Health Information Sciences also collaborates on projects at Memorial Hermann
Jiajie Zhang, Ph.D.
When you’re sick, filling out your medical history – and trying to remember the current dosage of your medications – may seem like one more headache. How much easier and more accurate it would be if you and your doctors could share your medical records electronically.
A national initiative to establish a medical electronic records system within the next 10 years is fueled by a desire to improve patient safety and system efficiency, while also reducing costs.
Potential benefits are more than saving patients time and headaches. Practical advantages include legibility, simultaneous viewing by multiple clinicians and remote access. Advanced features might offer integrated computerized decision support, such as instant drug-to-drug interaction checking and drug dosing calculations.
Current research at The University of Texas School of Health Information Sciences at Houston (SHIS) puts it at the forefront of this effort.
Human-Centered Computing
The biggest challenge, according to Jiajie Zhang, Ph.D., associate professor and associate dean for research at SHIS, is that the Health Information Technology Project is not just an information technology (IT) project. It also has a human component.
“At this time most IT systems do not consider issues of human-centered computing, and half of them fail,” Zhang said. “That is, systems are either totally abandoned – not used at all – or completely redesigned. The thing they fail to consider is the end user. But if we do it correctly, we can improve efficiency, quality and safety.”
Under existing medical records systems, an estimated 770,000 medication errors occur at U.S. hospitals each year. However, medical electronic records systems also have raised some safety concerns, as reflected in an article published earlier this year in the Journal of the American Medical Association about the role of physician order entry in introducing medical errors.
Patient Safety
Current research at SHIS focuses on patient safety, especially on understanding how IT and medical devices can induce or prevent medical errors, under grants from the National Institutes of Health and the U.S. Army.
In addition to safety, other challenges include costs and the lack of an industry standard to ensure compatibility, Zhang said. Human-centered computing is the key element that can facilitate implementation of a new national system, according to a pair of articles he and his colleagues published this year in the Journal of Biomedical Informatics.
Established six years ago, SHIS has special expertise in human-centered computing, with four of its 15 faculty members specializing in this area. Although approximately 70 academic programs in medical informatics have been established in the United States, only SHIS and a program at Columbia University are working in human-centered computing. Many of the 18 Ph.D. and 70 M.S. students currently enrolled in Houston are participating in the research; about one third of the students are practicing physicians or fellows, one third are nurses, and the rest are computer science majors.
Zhang said they are investigating how to design and evaluate systems and requirements for developing a good system. Evaluation involves gathering data from simulated tasks performed by physicians and comparing data to pre-electronic medical records results to identify potential errors.
Projects at Memorial Hermann
In addition, the researchers are working with Memorial Hermann Healthcare System (MHHS), which already has its nine area hospitals linked by a common software, allowing physicians at all its locations to quickly retrieve medical records for patients. SHIS researchers collect data at Memorial Hermann on workflow, analyze data and identify needed features.
During the past year, Memorial Hermann has:
- implemented digital radiology that allows physicians to view x-rays via computer,
- enabled a single-sign-on capability within a single portal so that physicians can get all information from a Web site,
- launched a cardiology system that allows digital image storage and access of cardiac catheterization and echocardiography images,
- deployed online physician documentation for its Children’s Hospital Neonatal Intensive Care Unit.
The primary focus is Memorial Hermann Hospital in the Texas Medical Center, according to Robert Murphy, M.D., assistant vice president and medical director for information systems at Memorial Hermann. Rolling out over the next 12 to 18 months will be a clinical documentation system that records care by nurses, physical therapists, respiratory therapists and other caregivers to allow nurses and clinicians to document care via computer and access the information in their offices and from remote locations. Another new feature will be a computerized physician order-entry system that will allow physicians to enter orders directly.
MHHS is working with SHIS on a project that will centralize data from all emergency departments in the system to allow analysis of unusual patterns that could indicate disease outbreak. Another joint project is the development of prototype applications for communication between health centers.
Exceptional Patient Care
“Together, The University of Texas Health Science Center at Houston and Memorial Hermann are deploying the most advanced, innovative technology available to further develop Memorial Hermann’s exceptional patient care experience,” Murphy said. “The academic research and development opportunities with SHIS are enormous and really exciting.”
UT physicians are pushing these efforts as much as anybody else, Murphy said, even though the new systems involve quite a bit of change in clinical care at the bedside. “I’m excited to have the opportunity to work with an innovative, excited medical staff that is continually driven to be the best,” he said. “This is one of the most important breakthrough initiatives for Memorial Hermann.”
By Sonora Hudson