Using Computers To Advance Health Care

Research in Action

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Using computers in health care can improve the quality and effectiveness of care and reduce its cost. However, adoption of computerized clinical information systems in health care lags behind use of computers in most other sectors of the economy.

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Key Research

Through its aggressive research program, the Agency for Health Care Policy and Research (AHCPR) is on the forefront of efforts to increase the use of computers in health care. Several projects funded by AHCPR that laid the foundation for using computers in health care are being used by the private sector.

As these AHCPR-funded projects show, computers can improve quality and cut costs in many uses.

Improved Quality

Automated hospital information systems can help improve quality of care because of their far-reaching capabilities. An example is the HELP system, one of the first information systems in a hospital to combine the use of computers for storing and transferring information with using them for giving advice to solve clinical problems.

• Use of the HELP integrated system showed that the risk of wound infection decreased significantly when antibiotics were given in the 2 hours before surgery at LDS Hospital in Salt Lake City. This was the first study of how timing of prophylaxis affects surgical wound infections in actual clinical practice.
• The HELP system detected 60 times as many adverse drug reactions in patients as the traditional method at LDS Hospital. The computer-detected reactions—95 percent of which were moderate to severe—occurred in 648 patients over 18 months.

In addition to alerting physicians to abnormal and changing clinical values, computers can generate reminders for physicians. For complex problems, computer workstations can integrate patient records, research plans, and knowledge databases.

• Physicians reminded by computer were twice as likely to give flu vaccine to patients at high risk during the winter in a 3-year trial by Indiana University investigators. Because the high-risk patients were vaccinated, winter hospitalizations, emergency room visits, and tests for respiratory ailments were reduced by 10 to 30 percent.
• Computer alerts for physicians prevented serious kidney failure and preserved kidney function in patients at Beth Israel Hospital in Boston. When creatinine levels (indicators of kidney function) rose in the patients, the computers alerted the physicians, who stopped medications being given or adjusted doses more than 21 hours sooner than when there were no alerts.
• Use of highly interactive HIV workstations for physicians at Beth Israel Hospital resulted in a 20-percent decrease in hospitalization of HIV patients, increased use of primary care, and improved quality of care. From any of the 2,000 terminals at the hospital or from home by telephone dialup, clinicians can access the patient data base and the HIV knowledge data base for improved patient care.

Computers and databases can be used to compare expected results with actual results and to help physicians make decisions.

• The quality of care of intensive care units (ICUs) can be assessed with the Acute Physiology and Chronic Health Evaluation (APACHE), which can compare observed with expected survival rates. Reflecting data from 17,400 ICU patients, the APACHE III data base can be used to adjust mortality rates to account for differences in severity of illness.

The lives of patients can be improved if they use computer systems to obtain information, make difficult decisions, and contact experts and support groups.

• HIV-infected persons who used CHESS (the Comprehensive Health Enhancement Support System) reported fewer and shorter hospital stays (and a 40-percent decrease in hospital costs) compared with nonusers. By interacting with the home-based computer system, users monitored their health and spotted warning signs of serious illnesses so they could alert their doctors quickly.

Decreased Costs

When a physician orders a test by computer, it can automatically display information that promotes cost-effective testing and treatment.

• Total costs at Wishard Memorial Hospital in Indianapolis decreased $594 per admission (projected hospital savings: more than $3 million) when physicians used computers to write all inpatient orders. The workstations were linked to a comprehensive electronic medical record system. Total charges per admission were $887 less when workstations were used to write all inpatient orders at the hospital; tens of billions could be saved nationwide.
• Physicians ordered 14 percent fewer tests per outpatient visit when using computer workstations at a large primary care facility in Indianapolis. Workstations showed prior test results, predictions of abnormal results, and test prices.

Vision for the Future

The much vaunted information superhighway is expected to improve the quality of life for all Americans. This vision—the National Information Infrastructure—consists of both existing systems and technologies and others still to emerge, all linked nationwide. Every part of the economy, including health care, will be affected.

AHCPR strongly supports research to make this vision a reality. A fully functioning nationwide system will allow the easy yet protected exchange of information among doctors, nurses, consumers, hospital departments, insurers, and researchers. Americans will benefit both directly (from immediate access to patient records during emergencies) and indirectly (from research linking data from many sources).

As part of the High Performance Computing and Communications Program, AHCPR works with other Federal agencies to provide key computing, communications, and software technologies to meet the demands of the 21st century. AHCPR-supported researchers are:

• Developing an entirely paperless medical record system at Beth Israel Hospital in Boston that links computerized patient records with different departments, physician offices, and 20 satellite clinics.
• Developing a practical common medical terminology that will be the basis for computerized patient records, clinical decision support, health services research, data-driven guideline development, and electronic interchange of patient information. The Mayo and the Kaiser Foundations are collaborating on the project, which is cofunded by AHCPR and the National Library of Medicine.

Uniform Standards and Data

For information from different databases to be compared, common terminologies and standards and uniform identifiers are needed.

In supporting the private development of standards, decision analyses, and access applications, AHCPR works actively with national and international organizations that set standards. Since 1992, AHCPR has sponsored meetings of the Healthcare Informatics Standards Planning Panel of the American National Standards Institute (ANSI) and its successor, ANSI's Healthcare Informatics Standards Board. The Board is a private-sector, nonprofit coordinator of organizations developing national and international standards.

Two new databases demonstrate the usefulness of uniform data, allowing comparison of health care services, medical effectiveness, and the use and cost of hospital care. Both data bases contain patient information for typical hospital stays in a uniform format while protecting privacy. One data base covers inpatient care in community hospitals in 12 States; the other is a national sample of some 900 hospitals. Part of the Healthcare Cost and Utilization Project, these databases cover 1988-92.

Confidentiality, Privacy, and Security

Improving the quality of care through the use of computerized medical information systems must not override the need to protect individual rights to privacy. Strong safeguards must protect confidentiality. Patient rights, provider rights, and other concerns are being addressed to prevent inadvertent disclosure or alteration of computerized medical records. For example, AHCPR cosponsored a conference that included proposals for strict limitations on access and heavy penalties for abuse.

AHCPR Publication No. 96-P014
Current as of January 1996