New Technologies Emerge

by STEVEN P. GRAY

PHARMACY ROBOTICS
Robots have been developed that can receive a computer message defining a drug order, pick unit doses of the ordered medication, insert the doses in a pneumatic tube, and dispatch them to the correct patient care unit. These systems can also fill unit dose bins for the daily cassette exchange and could have a significant cost-reduction impact on the logistics portion of the hospital pharmacy function. The robotic pharmacy appears to be most effectively implemented in conjunction with decentralized clinical pharmacists who review and process medication orders on patient care units. Another widely used and complementary technology is the automated medication dispensing devices. These are used for "as needed" and narcotic doses and are located in the patient care units.

• Issues to be resolved by further development and fine-tuning at initial installations of these robots include:
• Detection and elimination of error rates (very low, but quality control procedures must be in place).
• Additional studies to illustrate the cost-effectiveness of these devices.
• Further development of pharmacy practice, clinical pharmacists and automated medication dispensers, to optimally utilize these robots.
• Integration of supporting information systems to link all components of the medication system.

TELEMEDICINE
Providers have used teleradiology for years to transmit images electronically to radiologists for interpretation and study. The development of miniature cameras and probes, together with continuing advances in high-resolution video and computer enhancement software, has enabled a series of new telemedicine devices to be produced. Using these diagnostic devices, providers are operating mobile and facility-based clinics for vascular; gastrointestinal; ears, nose and throat; and dermatology patients.

Technologists and technicians can operate the equipment and perform the procedures, and the physician may be miles away reading the images and diagnosing problems. Voice links allow the doctor to specify additional imaging and to prescribe follow-up and treatment.

These devices, and their supporting communications networks, increase the productivity of physicians, as well as enable access to specialists who may otherwise not be available to some patients. Electronic archiving of the images, and multiple-point access to them, are ancillary benefits derived from these new telemedicine machines. Anyone managing or providing care in a regional, multisite delivery system should evaluate the applicability of telemedicine technology.

IMAGE MANAGEMENT
Related to, but separate as a set of products, is the collection of improved image management systems. As the use of CT scan, MRI, and ultrasound imaging devices has grown, the pressure to electronically archive and transmit the images from these devices has increased. Generally referred to as PACS (picture archiving and communication systems), this group of hardware and software products is enjoying sales growth and acceptance by clinicians.

While all film cannot be eliminated yet, PACS are justified through operating cost reductions. These systems reduce technical time, radiologist time and consumables costs. In addition, they eliminate much of the clerical expense of handling film and paper. The real benefits of PACS, however, lie in the ability to link primary care and specialist physicians to the imaging function with instantaneous electronic transmission of images and reports. Thus, when an image has been acquired from an emergency patient, the emergency room physician and radiologist can immediately review the image in separate locations and discuss the case by voice link. No film processing, no film transport, and no staff time or consumables cost is associated with this process. The image is then archived electronically with other previous radiologic studies for that patient. All studies for that patient can be instantly retrieved and displayed anytime a clinician wants to review the medical history.

In developing health delivery systems containing multiple sites, both for imaging and actual patient care delivery, electronic image management systems will be a necessity, if competitive advantage is to be maintained. Attending physicians will be increasingly linked to patient records via electronic systems, and they will expect the same instant access to images as they do to stock quotes and bank accounts.

Impediments to implementing PACS technology include competition for capital, and the lack of a sufficiently developed local area network and wide area network communications platforms that can efficiently, and with acceptable speed, transmit images. While intranets and the Internet appear to be solutions to the communications problem, concerns over data security exist. Further developments in information technology promise to solve the network deficiency issue.

Competition for capital is a problem for all technologies, but particularly so for PACS because of the size of the required investment. Instead of the hundreds of thousands of dollars required by other technologies reviewed here, PACS requires millions of dollars of investment. Nevertheless, providers are investing more in PACS every year. Prices are decreasing, and PACS systems are being assembled in pieces over several years, so each year’s expenditure is achievable in the overall capital budgeting process. Finally, recent studies show that, in total cumulative costs over a 10-year period, PACS is cost-effective. As wages continue to climb, and PACS hardware prices continue to fall, this cost justification requirement will favor the implementation of PACS. This technology should be a planning and investment priority for provider management.

VOICE RECOGNITION
For many years, we have been promised computers that can convert our speech directly to printed or displayed documents (see related article on page 44). Health care organizations, partly in response to managed care and regulations, have gradually increased the amount of documentation generated for each episode of care and for patient records in general and are spending hundreds of thousands of dollars each year transcribing this dictated and written documentation.

Researchers have been developing voice recognition systems for more than 10 years. Recent advances in audio devices, such as microphones, and computer processing speeds have appeared to breach the barrier to effective, user-friendly voice recognition systems.

The new voice recognition technology will convert speech to printed or displayed documentation without the need to preprogram the user’s voice. Any user can speak into the microphone and his or her speech will be converted to a document. Corrections can be made by simply moving a cursor to the location of the correction, and speaking the replacement words. Full dictionaries and recognition capabilities for all medical terminology reside in the systems.

With this new technology, a radiologist or surgeon can dictate a report, read it on the screen, electronically sign it, and make the report instantly available to attending physicians and record archives in digital or printed form. Each work station costs between $12,000 and $15,000 depending on the number purchased. As a complete replacement for expenditures for transcription staff and/or contract services, however, this technology appears to be easily cost-effective.

Regardless of your technology investment priorities, be sure to complete a rigorous life-cycle cost analysis of each investment to ensure that it is a wise financial decision. The technologies reviewed should be cost-effective in most health care delivery venues.