Healthcare is a profession that requires intensive documentation, timely actions and response, as well as high level of human skills for delivery of quality healthcare. There has been an effort since extremely long time to bring in information technology and digitization into the realm of healthcare. The result has been in isolated pockets and digitization is being witnessed more in diagnostic efforts and aids. These isolated pockets have resulted in extremely sophisticated diagnostic equipment starting from digital X-Ray machines, blood analyzers, ECG (Electrocardiogram) machines etc.. The digitization efforts has so much so intensified in the area of healthcare that digital Echo machines have begun to replace stethoscopes, which are the classical identity of medical practice.
Simultaneously, there has been concerted efforts to focus on the delivery of entire healthcare process in a holistic approach. Information systems and technology have enabled quickening of delivery of services, assembly of inter-disciplinary teams and response, especially in the emergency medicine scenario. This paper focuses on before and after implementation of information technology in the emergency medicine department. This process specifically looks at dealing and management of patients with acute cardiac conditions and the response to it by the care delivery system.
Before Implementation of Process and Change
The ambulance carrying the patient would confirm by a two-way radio that it is carrying a patient with a suspected cardiac condition and the emergency room must be ready to receive the patient who is being brought into the hospital. The best of diagnostic equipment in the ambulance would be limited to the classical stethoscope and the only preparation for treatment would possibly be an insertion of IV cannula. The patient’s would be received at the emergency room and quickly carted into the emergency wing of the hospital. The physician on duty would look at the vitals and order for an ECG.
The ECG technician would cart the ECG machine and take a paper based ECG.
Looking at the ECG the physician would make a decision to call in other specialist doctors and team members and inform the telephone exchange. The telephone exchange would then begin to call the interdisciplinary team members who would quickly assemble at the emergency room. At this stage, each of the team members would take turn to examine the patient and order different labs and diagnostics to be done immediately. In case, the patient is not conscious, or in other emergency physical state, they would start the initial medications without the lab and other diagnostic results based on their experience. The emergency room assistant would rush the samples to the laboratory, classifying them as an emergency. The lab technician would then quickly run the analysis, print the results out, and call the emergency room assistant to pick the lab results. The emergency room assistant would then rush to the lab to pick up the results and rush back with the printed reports.
The waiting interdisciplinary team would then take into consideration the results of the lab reports and make modifications to the treatment that has already been started or begin the treatment at that point of time. They would put in all efforts to stabilize the patients and once the patient begins to be stable, he would be moved to the intensive care unit (ICU).
The entire process with the intervening process times would be something close to about 120-150 minutes. This is a very long process time and the golden first hour after a cardiac incident, which is extremely valuable in the recovery process for a patient, is fully lost, almost always without required interventions. This translates to a higher possibility of mortality in the emergency cardiac cases.
After Implementation of Process and Change
As the ambulance picks up the cardiac patient, the ambulance technician attaches electrodes to the patient for a five lead ECG. He records this ECG on a digital ECG machine. After the ECG, he takes recordings of blood pressure, oximetry, temperature, and other basic vitals of the patient in the first 10 minutes of the drive to the hospital. While he continues to monitor the pulse and other vitals, the machines connect to a base station in the ambulance with the help of Bluetooth, and the base station forwards this information to the base station at the emergency room via the internet.
The monitoring physician at the emergency room identifies the cardiac incident and announces code blue in the emergency room. Code Blue is the standard May Day call in case of cardiac incidents. The code blue is transmitted to all the members of the interdisciplinary team on tier mobile smartphones. The members of the interdisciplinary team rush to the emergency room and start looking at the information that has already arrived on the system and form opinions on the patient condition and even the course of initial treatment, while also advising the ER nurse on the labs and diagnostics to be done.
This happens even as the patient is wheeled-in to the emergency room and additional electrodes are being fixed for facilitating a complete eight-lead ECG. The interdisciplinary team rapidly examines the patient while the ER nurse draws out blood samples and rushes the same to the lab. The technician runs the blood samples through the analyzers. The results of these tests are seamlessly uploaded onto the system which is instantaneously available and the emergency room. The interdisciplinary team which is already attending to the patient looks at the lab reports and continues or alters the course of treatment. The time cycle in this IT-enabled process is approximately 20-25 minutes in comparison to the 12-150 minutes in the manual system. The primary advantage in this method is the time compression achieved, allowing specialists to deliver care well within the golden hour, thereby reducing mortality rates in the emergency room.
Obstacles to Implementation
The primary obstacle to implementation of this highly sophisticated IT-enabled system is the capital costs of equipment and the infrastructure. There is a requirement of high capacity LAN networks, sophisticated equipment that hook seamlessly into the IT infrastructure (Glandon, 2013). There is also a need for Wi-Fi enabling the ambulances that respond to these kind of events. The second obstacle that comes in is the time and effort that needs to be invested into training of manpower in effectively using the newly introduced technology and the sophisticated systems in an appropriate manner. The last but a key obstacle to implementation of such sophisticated systems is the resistance to change in all the human elements that partake in the delivery of care. The IT enablement of processes in healthcare dramatically reduce timelines, while also enhancing quality, effectiveness and efficiency of the care delivery. However, the limiting factor is the human skill element which cannot be replaced in the current foreseeable future.
References
Beaver, K. (2003). Healthcare Information Systems. Florida: CRC Press LLC.
Gerald L. Glandon, D. H. (2013). Information Systems for Healthcare Management. Health Administration Press.
Walshe, K. S. (2011). Health Care Management. NY: Open University Press.
