UT Southwestern's Clinical Services Initiative Using information technology to improve patient care

by David Orenstein free-lance writer

A large part of UT Southwestern’s impressive funding drive (more than $300 million in fewer than 3 years) is the “Clinical Services Initiative,” an effort to improve clinical care and patient service. A large part of that is improving the medical center’s use of information technology. Indeed, although the initiative goes well beyond mere computing, IT will help shape the sweeping operational changes ahead.

The scope of the changes is vast. The center’s 50 clinics in five buildings up and down Harry Hines Boulevard handle 500,000 outpatient visits a year. The center also includes two hospitals with a total of 400 beds. To serve its clientele, UT Southwestern is working with software vendor EPIC Systems of Madison, Wis., to implement electronic patient registration, scheduling, medical records, and messaging. The process began in Summer 2002 and won’t wrap up until 2006, according to John D. McConnell, MD, executive vice president for Health System Affairs at UT Southwestern.

“This is not just a software package on PCs,” Dr McConnell says. “It is a complete reengineering of clinical processes.” That is a key point. The change in technology goes hand in hand with a change in how physicians, nurses, and others will do their jobs.

One of the biggest changes will come from the medical center’s new Picture Archiving and Communications System. This electronic way of handling medical images will allow physicians to call up X-rays in any clinic on campus.

Changes will start at patient registration. To take full advantage of the instantaneous nature of the electronic system, nurses and clerical staff will enter more patient data immediately upon registration so it is available to physicians when they see the patient. With a paper-oriented system, employees often were inclined to enter data after a patient encounter.

Physicians, meanwhile, will be encouraged to forgo dictation in favor of fill-in-the-blank templates that gather information for medical records (and comply with regulations) more efficiently. Although some physicians don’t relish the idea of typing, Dr McConnell acknowledges, the system’s “intelligent text” can be a more effective way than dictation to enter information.

Another example of how technology and process change will occur together is through the integration of electronic messaging with patient records. Although physicians will continue to have standard e-mail (for academic use, for example), they also will have a clinical messaging system that captures their communications regarding patients within patient medical records.

It is hoped that the above changes will make clinical care and information more complete and accessible, but patients will experience them only indirectly. The center, however, also is testing a system that would let diabetic patients in the family practice division see their lab results online. Among the questions, Dr McConnell says, is how best to annotate results so patients interpret them correctly.

The overall EPIC rollout has begun with pilot tests in the cardiology and family practice departments. Each clinic rollout takes from 6 to 12 weeks. After the outpatient clinics are completed, the implementations will reach the hospitals.

Work already had begun to implement some of these changes in 2002, but it had been proceeding slowly, Dr McConnell says. The center’s fund-raising success, including an anonymous $50 million gift in November, allowed the pace to quicken considerably.

When software strives to address a task as complex as the operations of a medical center, it necessarily affects how its users go about their tasks. The key to the implementation will be to get people to adjust to the systems and the systems to adjust to the people in such a way that the patients benefit.

David Orenstein is a technology and business writer in Silicon Valley. To learn more about a technology topic in Computing Care, e-mail him at davealli@comcast.net.