At first glance, the morning rounds on B-6 East at Cincinnati Children's Hospital Medical Center seem quite familiar.

        A knot of white-coated doctors moves from room to room in the medical-surgical step-down unit, conducting exams and discussing treatment plans in rapid-fire medical jargon.

Allison Habec, RN, enters information into a laptop at Cincinnati Children's Hospital Medical Center as Lee Anna Webster, 3, of Russellville, Ky., watches. (Glenn Hartong photos) | ZOOM |

        But instead of scribbling orders for medications and blood tests onto a traditional paper chart, this group enters the information directly into a computer.

        “Stat” orders for fresh X-rays are beamed instantly to radiology. Test results can be sent straight to digital pagers. And completely gone are those infamously illegible physician's notes.

        Children's Hospital is pumping more than $3 million this year into installing one of the most advanced documentation systems in the world of pediatrics. The idea is to reduce medical errors and save costs through improved efficiency.

        “We think we will solve about 30 percent of our medical errors with this system,” said Dr. Brian Jacobs, associate professor of pediatrics in the hospital's critical care division.

        Medical errors kill 5,000 to 15,000 people a year, according to a study published last year in the Journal of the American Medical Association by Dr. Rodney Hayward, director of the VA Center for Practice Management and Outcomes Research in Ann Arbor, Mich.

        Even in the best medical centers, errors can include giving the wrong medication, providing the wrong dose, failing to check for a known allergic reaction and missing potentially harmful interactions with other medications.

        To combat this, some doctors are turning to hand-held computers to write prescriptions. A small but growing number of hospitals also have started increasing electronic record-keeping.

A handwritten doctor's order, such as this one, is nearly obsolete. | ZOOM |

        But when treating children, medication issues are more complicated than in the adult world, Dr. Jacobs said.

        In a pediatric hospital, medications are given to a 1-pound premature infant one moment and a 180-pound teenager the next. When doses have to be constantly adjusted to weight, more errors can occur — and young patients often are less able to communicate a problem.

        The new computer system, made by Siemens Health Services and heavily modified by Children's Hospital, will combat many of these problems.

        The system automatically sends warnings when potential overdoses occur, such as skipping a decimal point on a prescription form. Warnings also pop up when drugs clash with allergies or other medications.

        Once the system is fully installed, key patient information will be instantly accessible to staff in different departments or on different shifts.

        “Before this, we had some of this information spread across nine different paper forms,” said Terri Ann Price, a nurse in patient services who has been deeply involved in launching the new system.

        Since April, the new system has been launched in four parts of the hospital — two patient wings, the operating rooms and neonatal intensive care. A bigger rollout is expected in September, when patients start moving into the new hospital tower under construction at the corner of Burnet and Erkenbrecher.

        By year's end, all in-patient services will be using the new system. Next year, the hospital plans to expand the system to outpatient clinics and satellite treatment centers. Ultimately, the hospital hopes to link the system to as many community pediatric physician offices as possible.

        While many staff members agree that increased computerization of medical records is needed, training more than 3,000 people to use the new system has been a challenge.

        “I was dragged kicking and screaming into this,” said 14-year nursing veteran Teresa Couch. ""The day we went live I brought my rosary with me because I thought prayer was the only way we were going to get through. But it turned out to be a good transition and now I can't imagine not having it.”

        Ms. Couch said she already spends less time sorting out illegible or incomplete doctor orders. She sees medication orders being filled faster and more accurately. And by being forced to immediately update paperwork, she says she winds up spending more time with patients.

        Doctors are still getting used to the new system, which requires an unprecedented level of data entry on their parts.

        For a complicated case — a common occurrence at Children's — it can take more than an hour to click through the various computer screen menus to enter a patient's diagnosis and vital signs, order medications and tests, and enter whatever special care instructions the patient needs.

        “It does slow things down,” said Dr. Barb Halliman, a pediatric resident. “It can take 90 minutes to admit a patient who needs a lot of meds. When the census is high, I feel like I'm spending a lot more of my time on paperwork instead of with patients. I've never felt as much like a secretary.”

        But once the front-end data entry is done, keeping track of how care is carried out becomes much easier, Dr. Halliman said.

        Other hospitals have reported improvements from such systems, Children's Hospital officials say. At Pitt County Memorial Hospital in Greenville, N.C., charting accuracy jumped from 62 percent to 95 percent in 1996, Ms. Price said.

        An estimated 3 percent of all hospitals nationwide have systems at least as comprehensive as the one at Children's Hospital, Dr. Jacobs said.

        In years to come, hospitals will have little choice about installing computers at the bedside, Dr. Jacobs predicts, because one serious error can cost a hospital millions to settle malpractice claims.

        “I see it as a financial and moral imperative for hospitals to get these kinds of systems in place,” Dr. Jacobs said.

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