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If a physician at Cedars-Sinai Medical Center in Los Angeles wants to check a patient’s lab or surgery results, those results are only a mouse-click away, thanks to the development of Web/ VS (web-viewing system) — designed by some of the facility’s own physicians. Recently, their access to information was even further enhanced as the system was adapted to accept Palm Pilot communication.
"But Palm Pilot usage is really the icing on the cake; the hard part was setting up and implementing the system," notes Michael Shabot, MD, director of surgical intensive care and medical director of the Cedars-Sinai Enterprise Information Services. "We now have a total of four physicians working either full- or part-time in IS [information services], which is very unusual," he says.
The system was developed in 1998, born of the recognition that "physicians’ expertise is in medicine and not in computers, nor is it ever going to be in computers," Shabot notes. "When we took over information services in 1997, we saw that physicians had learned to use the web and were pretty good at that. We had a lot of data that could be made available on a web-viewing system, but there was not — and still is not — a program that does that, so we wound up writing it for ourselves."
Shabot and his group created what he calls a "clinical data repository," which holds some, but not all, of the facility’s lab results, admission and discharge information, and dictation notes. "To write such a program for noncomputer-literate docs, you need some docs who are computer literate," he says, "But the system has to be logical and easy for docs to use." This system is very easy; in fact, there were never any classes held on how to use it. "The doctors wouldn’t have gone anyway," Shabot comments. "[America Online] taught docs two things: how to log on and how to use the web — how to click."
And that’s all the expertise that’s needed for this system. When on-campus, physicians just go to the site and use their log-on ID and password. When off-campus, the physician needs a digital certificate or a secure-ID card, created with sufficiently strong encryption to meet government standards. "As soon as they get in, it shows them their list of patients in the hospital," Shabot explains. "If they are consulting, they can just click on a patient’s name or ID number and go off to the data. Everything is there, including X-ray images, which appear in high resolution."
Other Cedars-Sinai systems hold specific data and serve up those data on request, Shabot explains. "For example, EKGs are stored on the EKG server," he says. "But when a doctor needs an EKG and doesn’t know where it is, he just views a list by dates and clicks on that date, and it comes up in a window."
The ability to access patient information, compared with that process before Web/VS, is "like night and day," says Shabot. "Before Web/VS, doctors waited for paper reports to be faxed or mailed to them. Now, most of that is eliminated; they can see results literally as soon as they leave the instrument in the lab."
The new system shortens the amount of time patients have to wait for results, but even more important, says Shabot, it shortens the time needed for physicians to see the results and make a change in treatment, such as different medications or dosages. "Patients are treated sooner and are able to leave the hospital sooner," he notes. "The whole point is getting the patient well quicker, and this is the way to do it. In the old days, you’d have to wait for CAT scan films to come out, then find the radiologist, read the films with him or her, and so on. Now, as soon as the images are done, they immediately go in the web server. I can literally see the results before the patient gets back to the room."
Most of the time, the physician doesn’t even need to go to radiology to consult about the results. "We can do it on the phone, since we’re both looking at the same image," Shabot explains.
With 1.9 million square feet under one roof, and a quarter mile to walk from one end of a ward to another, Cedars-Sinai was a particularly appropriate venue for a system like Web/VS, and the usage seems to bear this out. "We hit an all-time record high this Monday with 25,500 page hits — and that’s only our internal web server," says Shabot. He notes that Cedars-Sinai has about 800 inpatients on any given day and also serves thousands of outpatients a day. "We have about 1,000 physicians who have log-on IDs," he says.
The new Palm Pilot features required only a slight adjustment to the system, since all of the data were already Web-viewable, explains Shabot. "The Palm VII has Applets, so all we had to do was reduce the amount of data per screen to four or five columns vs. 10," he says. "Now, wherever a doctor is, in the car — hopefully at a stoplight — away from the office or at the airport, he can get the results he’s waiting for wirelessly. Now, you don’t even need a computer; I can call and get my ICU results from any metro area around the country."
The Palm manufacturer told Shabot that Cedars-Sinai may be the first institution to make information available in this fashion, but it seemed like a logical step to him. "They include a free software development kit on their web site," he says. "I had it shipped in from a computer store, got our technical people to download it, and within three days we had a working application I was able to use from home."
Will the Web/VS ever be made available to other medical facilities? "We’re looking to see if perhaps it could be made available through a third party," Shabot says.
For more information, contact:
• Michael Shabot, MD, Director of Surgical Intensive Care, Cedars-Sinai Medical Center, 8700 Beverly Blvd., Los Angeles, CA 90048. Telephone: (310) 423-5873.