A University of Michigan Health Minute News Release - October 2000: Written by Kara Gavin
ANN ARBOR, MI - Patients who go under the knife at the University of Michigan Health System can now feel more confident than ever, thanks to one of the first computer systems in the country to bring the power of instant electronic information directly into the operating room.
Made available in six UMHS facilities this summer, the new clinical information system helps both physicians and patients. It makes up-to-date patient history, test and medical data available from anywhere in the Health System — including on touch-screen computers in the anesthesiologist’s station in 42 operating and procedure rooms.
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MorCARE clinical workstation in the OR environment |
It also reduces the chances for medical mistakes, through logic-based safeguards and a library of the latest medical guidance on diseases and treatments. Called MorCARE, it was designed under the direction of anesthesiologists who saw that computers could revolutionize surgical care, and replace reams of paper records for more than 31,740 U-M surgical cases a year.
Now, its developers say, the pioneering program may pave the way for other hospitals to bring the Information Age into their operating suites, as doctors increasingly - and somewhat belatedly - adapt to a new wave of technology that much of America has already embraced.
“The patient’s life and well-being are dependent on us having the right information at the right time and in the right place, and this system allows us to do that,” says Michael O’Reilly, MD, MS, assistant professor of anesthesiology and director of the MorCARE project team. “We’re really leading the pack in this field, because we’ve taken the approach of looking at the entire surgical process from the time the patient’s seen in the surgical clinic, to the time that they have their surgery, and then following them postoperatively.”
In the new system’s name, coined by U-M Anesthesiology Department chair and project founder Kevin Tremper, Ph.D., MD, the Mor stands for Michigan Operating Room. But in fact, the software could serve health care professionals throughout UMHS and beyond.
Developed by Ann Arbor-based SEC, Inc., run by two U-M Medical School alumni, the program is related to SEC systems now used in U-M emergency, intensive care and trauma/burn areas. All are based in part on the Health System’s existing patient information database, the Clinical Data Repository.
MorCARE is the first implementation of SEC’s Perioperative clinical information system module. All of it is designed with Web-like hyperlinks to be user-friendly for the most technophobic staff. It’s also fully networked, and completely secure to protect patient privacy.
Even in its first months, MorCARE has proved better than old, paper-based ways, O’Reilly says. “In surgery, patients actually move through the system faster than the paper does,” he explains. “The patient may be seen in five different clinics on one day, and be scheduled for surgery the next day. For all of that paper to come together at the right place and right time is a challenge.”
Before MorCARE, U-M staff often found themselves in the pre-surgery clinic asking patients the same medical history questions that others had already asked before. Meanwhile, lab test results, medical images and other paper forms didn’t always get to the OR before surgery.
While the system worked, it certainly wasn’t efficient or immune to medical errors. And the often disjointed appearance didn’t help reassure patients about the people and hospital they were entrusting with their lives. The same is true of nearly every other operating room in the U.S.
“Now, we have a complete picture of everything about that patient, all of the medications they take, all of the adverse reactions that they’ve ever had in the past, and their previous surgical and other medical history,” O’Reilly says. “It allows the physicians to have the information we need to take care of the patient right at our fingertips. And it gives the patient confidence that we have all that information, that we know all about them before they get here.”
In fact, the new system even helps patients get seen faster in pre-surgery clinic and brought to the OR on time, with a real-time system for tracking how long they’ve been waiting. Patients can also feel confident that the system prompts staff to check that procedures are being followed.
The U-M’s anesthesiologists now use MorCARE constantly before and during operations. Using the online reference database, compiled from U-M experience and national guidelines, they can plan which anesthetics and techniques to use on patients with a wide range of health conditions. The system’s built-in connection with OR equipment lets them monitor a patient’s vital signs on one screen as the anesthetic takes effect, maintains sedation, and wears off. They can then generate an electronic record of those signs, rather than having write them down on paper.
MorCARE also offers features that make life easier and more streamlined for everyone in the operating suite, not just the anesthesiologist who holds each patient’s life in his or her hands.
The system keeps minute-by-minute track of which operations are under way, which are next to come, and who is operating, anesthetizing and being operated on in each one. This real-time OR schedule is available throughout the U-M Health System. MorCARE also serves as a centralized source of data on each patient for staff in the recovery room, and on the hospital floor. And, its logic-based construction customizes the display based on where the user is.
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MorCARE “wireless” workstation in the PACU environment |
In another paper-saving feature, MorCARE helps doctors quickly generate electronic records of what they did, and why they did it. These documents are crucial for the patient, the hospital and the insurance company. Now, rather than dictating every memo and record, and waiting for them to be transcribed, checked, and filed, the physician can use one of MorCARE’s templates, and insert the patient-specific information electronically. The system streamlines billing, too.
So why did it take so long for such a system to come into being? O’Reilly attributes it to resistance to change, and a bit of technophobia. “Medicine as a whole has been really slow to adapt information technology, and I think a lot of it has to do with how we traditionally do our jobs,” he explains. “We’re used to sitting and talking to a patient, and we’re used to writing on and looking at a paper chart, so it’s a bit of a change for us to go to a computerized system.”
MorCARE will also allow U-M physicians to collect and analyze clinical and surgical information much easier, making it possible to do research on how well patients and staff do under different conditions, and how patients recover afterward. Anesthesiologists will be able to develop guidelines within their department for care that’s efficient and cost-effective, but allows each physician some room for personal preference. This kind of large-scale research is very difficult with paper records, but could make a real difference in hospital practices and patient outcomes.
Now that the U-M and a few other large medical centers are breaking this ground, O’Reilly sees rapid progress ahead. “I think that MorCARE, or systems like it, are likely to be used in basically every operating room around the country in the next 10 to 20 years, given the explosion in information technology and how we use it,” he says. “Our job at the U-M is to help the process of creating knowledge from information, and MorCARE and tools like it will help us manage information in ways that allow us to create new knowledge and to take better care of patients.”
