"Smart" technology moving to clinics, physician offices

As the Glickman Urological and Kidney Institute at Cleveland Clinic grew and added on more physicians, the "flag and tag" system used to monitor patient flow turned into a sea of tags, flags and rubber bands that created confusion for even the most seasoned physicians.

When the 50-physician practice started planning for its new facility, set to open in November, it decided to adopt radio frequency identification technology, an approach commonly found in hospitals but not yet making strong inroads into ambulatory care settings.

RFID technology tracks the flow of both patients and employees who wear encoded wristbands or badges. Physicians can check computer monitor displays to determine which patient has been seen by which practitioner and how long each patient has been waiting.

While many of the solutions offered by smart technology such as RFID are common to inpatient settings, technology companies are just starting to see opportunities in outpatient and ambulatory settings as well.

The term "smart technology" is derived from the acronym SMART: self-monitoring, analysis and reporting technology.

The term has evolved into a catch-all phrase that includes other synchronizing and monitoring technologies, such as Bluetooth.

Clinic leaders at Glickman approached a vendor whose technologies were being used solely in inpatient settings to see if the devices could be adapted to settings at the Cleveland Clinic. This was the first outpatient project for the vendor.

Wendy O'Connell, administrator for the Glickman Institute, said the clinic is already thinking of other ways to use the technology, such as for equipment inventory, for example. The electronic tracking and reporting automatically generated through RFID will help her determine how much time can be saved when searching for specific pieces of equipment.

As the technology evolves, more solutions are becoming adaptable to small practices.

For example, some data management companies are using RFID technology to help physicians make their inventories of files, medical supplies and equipment more efficient.

RFID tags can record information such as the contents of each box. By attaching an RFID tag to each box of patient data, physicians will always know the exact location of a patient's file, allowing for quicker retrieval.

The tags, however, cost about 50 cents each, compared with the less than a penny cost of bar-code stickers. Implementing RFID technology would also require hardware, including scanners and encoders.

Physicians who are not ready to adopt the technology in their practices likely already have encountered it at the hospital -- or if not yet, then soon will.

Banner Health, a Phoenix-based nonprofit system that has hospitals in seven states, adopted smart room technology with the opening of Banner Gateway Medical Center in Gilbert, Ariz., in November 2007.

Carmen Oliveras, MD, a hospitalist with Banner, said the evening shift at the hospital will never be the same thanks to the eICU system that is part of the smart room concept.

eICU allows the constant monitoring of patients from a remote location staffed with intensivists and nurses who have access to each patient's vital signs and also a live video feed of the patient. The remote intensivists can monitor patients, examine them, give instructions to the on-site nurse or decide to page the doctor on duty.

"Before the eICU was operational you were continually being called or paged about patients that are sick, so it's nice having someone that can take these calls off of you, and have the peace of mind that someone is watching the patient," Dr. Oliveras said.

Other physicians have learned that smart technology can help bring some order to the information overload that can occur when multiple doctors care for one patient in an electronic environment.

After Children's Hospital of Pittsburgh, at the University of Pittsburgh Medical Center, adopted an electronic medical record six years ago, physicians there were experiencing a lack of "situational awareness," said James Levin, MD, PhD, chief medical information officer of the hospital.

Dr. Levin said there were so many charts and places where data were kept that it made it difficult for physicians to get their bearings and determine what was the most pertinent information.

New software, which the physicians call the "critical-care dashboard," collects data from all the various sources, including the hospital's computerized physician order entry, lab results, e-prescribing system and the nurses' notes, and summarizes it for display on a screen next to the patient's bed.

Nikunj Doshi, DO, an internist with Banner in Arizona, said it's mobile smart technology that has made his visits with hospitalized patients more meaningful.

With mobile computers, Dr. Doshi is able to access imaging results that he can show to the patient when explaining a diagnosis.

"Once they understand and have a mental image of what is going on, they are not grasping at something more horrendous or if they have downplayed [their illness] and then they see it, they are shocked. Either way, the end result is a deeper understanding of what is going on," Dr. Doshi said.