By Adam Geller, The Herald-Sun
CHAPEL HILL -- Five hours into his shift at UNC Hospitals, attending physician Michael Harrigan surveys the chaos of the emergency department.
Patients occupy every room and extra beds crowd the halls. An elderly man in a wrinkled dress suit peeks out from the room, merely a curtain hanging in the hallway, closest to Harrigan.
Harrigan, perched at his command center, is outfitted with familiar tools: a computer for accessing hospital databases, two phones which ring often with transfer requests from other hospitals, a large desk pad -- the kind most people have for doodling -- full with handwritten details for 14 possible patient-transfers, a bank of monitors detailing patients status and, most importantly, cubbyholes containing the patient charts.
But this time-tested setup is about to drastically change. Today, the emergency department is implementing a new computer system called T-SystemEV that eliminates the need for writing and storing any paper charts .
"It will be a great improvement," said Harrigan. "[Currently] we do less medicine and more documentation."
The hospital is switching out doctors' pens and clipboards for mobile computers complete with 12-hour batteries and wireless Internet access.
This move by UNC is cutting edge, just like the new computers. Currently T-SystemEV is running in only 57 of the more than 4,000 emergency departments nationwide, and UNC is the first academic emergency medicine training center to have them.
Because attending physicians are busy running the emergency department in addition to seeing patients, they rarely can document their final diagnoses and treatments while delivering care.
"I'll spend eight hours seeing patients and another two to three hours dictating charts either at the end of the shift or the next day," said Harrigan. "That's an extra three workdays a month that I spend talking into a telephone."
After dictating a chart, the attending physician must wait to electronically sign the permanent record, which Harrigan said can pile up to be several hundred at one time.
With T-SystemEV, all care providers, including the nurses and doctors, will be able to electronically sign charts at the time of treatment, making them ready for final attending approval without need for dictation.
Adopting the new charting system is not just for doctors' benefit. The patient benefits, too, said Joe Lastinger, a vice president of T-System Inc.
"The biggest problem patients have is waiting times," Lastinger said. "The most frustrating thing that can happen is that ... you go to the emergency department and sit there for three or four hours or more."
With T-SystemEV, Lastinger added, an emergency department can stay more organized and efficient with ordering lab tests, documenting interpretations and sharing information among the treatment providers -- all leading to faster care.
"Once you get rid of paper, you can squeeze a lot of inefficiencies out of the system," he said.
The new system also eliminates illegible charts and discharge instructions. Doctors will now print computer-generated discharge instructions specific to each patient's medical condition.
Lastinger said the most beneficial feature, though, is "with our electronic system, we have zero lost charts."
The paper system doesn't boast the same track record. Harrigan pointed out that staff misplace or leave behind charts regularly. During a recent shift he worked, he said, nurses forgot to grab the paperwork for a patient with head injuries when moving him to the intensive care unit.
After a patient visits the ED, someone on staff must assemble the notes from the nurses and doctors into a complete chart; one copy is for medical records and another is kept as backup for three months.
Health Unit Coordinator Thomas Watson, whose desk was littered with the piles of pink, yellow and white carbon-copy forms from the night before's patients, handles the match-making.
"We have been told that it's going to be so much better," said Watson, pointing to the piles.
Watson has been in his job for 36 years. He said the promise of not searching for misplaced charts could save him a lot of time.
"I might just be technologied right out of a job," he joked.
To insure a smooth transition to the new system, UNC is requiring all E.D. staff to complete an Internet-based course and four hours of classroom training. During the first 10 days, the department also will over-staff to compensate for any initial slowdown.
And just in case the computers crash, as computers can do, patients need not worry. The hospital will be able to fall back on the old-fashioned paper system.
Copyright 2004, The Durham Herald Company. All rights reserved. Reprinted with permission.
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