Technology to improve care at the bedside and beyond

Much has been written about the enormous effort required to take scientific discovery from the laboratory bench to the patient’s bedside. In the Supplement to the February issue of the Journal of General Internal Medicine, Brad Doebbeling, M.D., M.Sc., and colleagues offer strategy on how best to take the next step, to use technology to incorporate new or better treatments at the bedsides of patients treated anywhere.

In the paper, Dr. Doebbeling, director of the Indiana University Center for Health Services and Outcomes Research of the Regenstrief Institute Inc. and director of the Veterans Affairs Center for Implementing Evidence Based Practice in Indianapolis, calls for the partnership of health services researchers, information technology specialists, and physicians.

“Information sharing is crucial,” said Dr. Doebbeling, who also is professor of health services research and medicine at the Indiana University School of Medicine. “If banks can have ATM machines all over the place while protecting the confidentiality and security of financial data, why can’t we do the same thing with health data, allowing those who need access to medical data to be able to do so, no matter if they are in a doctor’s office or in a community hospital nearby or a medical center across town?

“This paper provides strategies and priorities for partnering to change the complexion of health care,” noted Dr. Doebbeling. “One priority is the establishment of data warehouses and data sharing across health systems and locations. Having data available from across health systems can eliminate unnecessary and duplicate tests as well as provide information as it is needed.” Strategies include careful planning, implementation and evaluation of technology in care delivery, user feedback, and local adaptation to incorporate technology in the workflow and processes of care.

Many of the strategies and priorities to which Dr. Doebbeling refers are under development. The VA medical system already has an electronic health record used in all its facilities, electronic prescribing and is increasingly using telemedicine technology to improve quality and safety.

Regional health information exchanges, which allow medical records to be seen at any of a number of hospitals in a geographic area, have grown out of pioneering work from the Regenstrief Institute. Today the Regenstrief Medical Record System, the Indianapolis Network for Patient Care and the Indiana Health Information Exchange serve as nationally cited examples of the strategies that might be utilized to share health information, and make medical advances and adherence to standards of care widespread.

Stimulated by the desire to get the latest treatment options out to community physicians as well as the need to bridge the gap between the current standards of care and optimal care, this paper identifies opportunities to better incorporate health information technology in care delivery.