innovate arkansas

The doll collection at Arkansas Children’s Hospital has gone high tech.
The life-like dolls are the main feature in the hospital’s new pediatric simulation building, called the PULSE Center, where medical students can practice techniques ranging from listening for heartbeats to cutting throats for tracheotomies on the computerized dolls.
Arkansas Children’s Hospital and other medical centers around Little Rock are turning to technology for everything from better entertainment centers in patient rooms to faster access to medical records.
And the move is paying off.
Hospital officials say the high-tech devices they’ve installed now have their hospitals running more smoothly and patients recovering faster.
St. Vincent Medical Center in Little Rock said it’s creating an electronic patient record bank. When a patient walks into one of St. Vincent’s hospitals or its dozen clinics around the state, a physician will be able to call up the patient’s medical record instantly to see what’s been done at any St. Vincent facility.
“It allows you to draw an extraordinarily comprehensive picture of the care that patient has received regardless of what type of care or where it was rendered,” said St. Vincent spokesman Scott Mosley.
The daunting task of setting up the system will cost several million dollars, he said.
A 2005 study by the American Hospital Association found hospitals are committed to using information technology, but some were slow to
dive into it because of the cost.
The median annual capital investment on IT was more than $700,000, and it represented 15 percent of all capital expenses, the report said. Operating expenses were higher still — $1.7 million, or 2 percent of all operating costs, the report said.
“The most commonly cited barriers to further adoption of IT are initial investment costs, followed by lack of interoperability with current systems, acceptance of technology by clinical staff and availability of well-trained staff,” the report said.
President Bush set a goal of having electronic records for all Americans by 2014.

Electronic Record-keeping

In St. Vincent’s emergency room, patients’ records have been stored electronically for about two years.
In the nurses’ station, a 52-inch wall-mounted monitor displays all the names of the patients, their room numbers and symptoms.
“From there, there’s all kinds of information you can get from [the computer system],” said Rhetta Bennett, a registered nurse in St. Vincent’s emergency room.
Most patients have made previous trips to St. Vincent’s emergency room. After accessing a patient’s name, the nurse or doctor can determine the medications the patient is on, the last time he was in the hospital and any allergies he may have.
“Now we can enter your number into the system and pull up all of your information right there without having to wait for medical records to find your chart and physically bring it here,” Bennett said.
She said the system eliminates wait time for the patient.
St. Vincent is targeting 2008 to have its entire patent medical records filed electronically so they can be called up and used at any St. Vincent facility.
“We’ll be able to eliminate duplicate tests that patients now have to go through because you’ll have those results on hand quicker,” said Tommye Billing, vice president and chief information officer for St. Vincent.

Fun and Games

Arkansas Children’s Hospital in November unveiled a pilot program in its cystic fibrosis wing that features Xbox 360s with 32-inch flat-screen high-definition television sets.
In the 15-bed wing, all rooms also have a 15-inch touch screen that acts as a remote control for the TV and much more, said David Higginson, chief information technology officer at Arkansas Children’s Hospital.
The doctors can call up X-rays on the screen, and patients have limited access to the Internet. Patients also can watch age-appropriate movies with the “on demand” system.
With the screens in the rooms, patients can view information about their illnesses as well as keep up with which doctor is going to see them that day.
“It’s the patient’s link to the electronic world,” Higginson said.
Higginson said that in the next two months the hospital will decided if it will retrofit other rooms with the entertainment centers, which cost $4,000 per room.
Young patients enjoy the diversion the centers provide, but there have been unintended consequences. One patient stayed up until 4 a.m. playing Xbox games and slept until noon the next day. While he didn’t miss any scheduled medical procedures, the staff decided to put a curfew on the game consoles.
The new game systems also might be an incentive to stay in the hospital. One patient said he wanted to come back to the unit because he didn’t have as good a system at home, Higginson said.
Across the street from the hospital, in the newly opened PULSE Center — that’s Pediatric Understanding & Learning through Simulation Education — medical students are playing with dolls. The computerized mannequins can be made to simulate the symptoms of a sick child while the trainee practices starting an IV, inserting a ventilator or other medical techniques. Video cameras capture the students’ actions and reactions so that they can learn from their own successes and failures.
“Health care is one of the few industries in which new clinicians are expected to perform procedures without extensive experience,” Beth Petlak, Arkansas Children’s Hospital vice president of business development, said in a news release. “The PULSE Center will allow them to practice these clinical skills in a simulated clinic or environment just as simulation is used in the airline industry to teach and maintain a pilot’s skills in the cockpit.”
The center cost $300,000 to set up, but hospital officials hope it will reduce the number of injuries that doctors inflict on patients. The Institute for Healthcare Improvement estimates that nearly 15 million incidents of medical harm occur each year, ACH said in its news release.
Arkansas Children’s Hospital trains most of the future pediatricians in Arkansas.
“That was the primary motivating factor for us to develop the PULSE Center here,” said Dr. Chris Smith, medical director of the PULSE Center.

Image-guided Surgery

In the summer of 2006, the University of Arkansas for Medical Sciences in Little Rock opened the first endovascular surgery suite in Arkansas.
The $1.2 million surgery suite can provide clear, three-dimensional pictures and low-dose X-rays for several minimally invasive procedures.
With the machines, surgeons can get inside the blood vessels to repair them rather than fix them from the outside of the vessel, said Dr. John Eidt, professor of surgery and radiology at UAMS.
“If you were working the plumbing in your house, if you can get inside the pipe, and you can work remotely with a camera or some kind of a robot, then you can fix the plumbing and patch it from the inside … without having to dig up the front yard,” he said.
The end result is “you can go home quicker,” Eidt said.
Now about 75 percent of the procedures for cardiovascular surgery are image-guided, he said. Five years ago, only 5 percent of the procedures were conducted that way.
“It continues to open up new opportunities for less invasive treatments with equivalent outcomes,” Eidt said.

‘An Extra Set of Eyes’

Baptist Health’s remote monitoring system for intensive care patients is going to be even more remote later this year.
In June 2005, Baptist Health opened a $6 million remote monitoring system where a team of nurses and doctors can monitor the intensive care unit patients in both the Little Rock and North Little Rock locations.
The 142 beds in the unit are wired for speakers, microphones and cameras so the off-site medical staff can monitor the patients, said Vicki Norman, director of the monitoring program, called eICUCare.
She said the control room isn’t designed to replace the nurses on the ground, but to enhance their work.
“We’re there as an extra set of eyes,” she said. “It’s really an innovation in care for our critical care patients.”
The computer system also contains software that closely monitors the patient’s condition and alerts the medical staff to any possible developing complications, Norman said.
“We capture all their vital signs real time,” she said.
And the medical staff in the control room can activate a camera in a patient’s room — which is focused toward the wall when it’s not in use — to see what’s happening. (Norman said a bell sounds when the camera is on to protect patient privacy.)
So far, the mortality rate has dropped 28 percent in the intensive care unit partly because of the work in the control center, Norman said.
In June, the eICUCare program at Baptist Health in Heber Springs is expected to launch. The vital information from that hospital will be fed into the computer banks in the Little Rock control center.
“We would monitor their patients from here,” Norman said. “Certainly, geography is not a limitation.”