Pa. hospitals go high-tech on infection tracking
By MARTHA RAFFAELE – Dec 30, 2008
HERSHEY, Pa. (AP) — At Hershey Medical Center, a sophisticated computer program serves as a watchdog for infection outbreaks.
With a few mouse clicks on a Web browser, the hospital's infection-control staffers can quickly generate reports with charts and graphs illustrating how many patients within a particular unit are infected, and which lab specimen contained the germs. "It's more for us to look at the hospital as a whole and look for trends," said Dr. Kathleen Julian, an infection disease physician. "Is there a cluster of problems in this unit?"
Pennsylvania health officials view the nascent technology as a critical tool for helping hospitals reduce health care costs by identifying potential systemic infection-control problems sooner than is possible by reviewing paper records by hand — an approach some health professionals call "shoe-leather epidemiology."
Using traditional investigation methods, infection-control professionals must spend hours poring over patient charts, but limit the scope of their inquiry to areas of the hospital where infection outbreaks are most likely to occur. With electronic monitoring, hospitals can cast a wider net, using software that employs algorithms to do the heavy lifting of sorting through every single laboratory, pharmacy and X-ray report that is entered into the hospital's computer network.
Gov. Ed Rendell's administration is expecting more hospitals to adopt the technology under a sweeping 2007 state law designed to reduce infections contracted by patients during their hospital stays.
"It frees up your infection-control people from trying to find infections ... so they can get out on the floor and put systems in place so they don't happen again," said Ann Torregrossa, policy director for the Governor's Office of Health Care Reform. Pennsylvania is the only state in the nation to include "electronic surveillance" — like the Hershey hospital's system — in its infection reporting laws, according to the Association of Professionals in Infection Control and Epidemiology.
Pennsylvania became one of the first states to mandate infection reporting by hospitals in 2003, and it was the first state to release public reports on infection rates in 2005.
Gov. Ed Rendell's administration championed the 2007 law as part of a broader health care reform agenda that includes reducing the cost of care. The administration has estimated that hospital-acquired infections add more than $3.5 billion annually to hospital bills in the state.
Monitoring infections has taken on greater urgency nationally with the emergence of antibiotic-resistant "superbugs" such as methicillin-resistant Staphylococcus aureas, or MRSA.
Also, in October, the federal government began withholding Medicare reimbursements to hospitals for preventable errors, including urinary tract and vascular infections stemming from the improper use of catheters, as well as certain surgical site infections.
Pennsylvania's law requires hospitals, outpatient surgery centers and nursing homes to develop state-approved infection control plans and report all infections to the Centers for Disease Control and Prevention. It also calls for the eventual awarding of bonuses to hospitals that reduce infections by at least 10 percent.
Rendell's administration originally sought a statewide mandate for the computerized infection tracking systems so that health officials could make uniform comparisons. But the state's hospitals fought back, arguing that the requirement was a costly mandate that would unfairly penalize small hospitals that have lower infection rates.
Under a compromise in the law, hospitals are allowed to opt out of the computerization requirement for now if they can demonstrate to the state Health Department that they lack the money or technological capability to do so.
Roughly one-fifth of the state's 163 general hospitals have told the department they will not install new monitoring systems, mainly due to budget constraints. The law requires each of those hospitals to have a written plan in place that explains how it will collect the data and a process for verifying its accuracy.
Other types of hospitals — such as psychiatric, long-term acute care and rehabilitation hospitals — are not being expected to install such systems because of their size or specialty, department spokeswoman Stacy Kriedeman said.
The hospitals that are proceeding are about evenly split between facilities that expect to meet the Dec. 31 deadline for implementing electronic monitoring and others that may need more time due to an overwhelming demand on the relatively small number of companies that provide the technology, said Stacy Mitchell, the health department's deputy secretary of quality assurance.
"We have to be flexible about that, because it's not the hospitals' fault," Mitchell said.
Electronic surveillance is a relatively new technology that has emerged over the past several years, and definitive studies on its cost-effectiveness are difficult to track down.
"It would be a complicated and expensive study to rigorously study whether there were cost savings," said Dr. William Trick, an internal medicine physician and researcher at John H. Stroger Jr. Hospital in Chicago. But Trick said his research has found that computerized monitoring can improve the efficiency and likely the reliability of infection tracking.
Trick and other researchers found that computer algorithms were more accurate than manual records reviews in detecting bloodstream infections associated with catheters inserted into a large vein, according to a 2004 study published in the CDC journal Emerging Infectious Diseases.
The algorithms were more likely to agree with a separate, independent review of the infection data than the determination of an infection-control professional who examined the records by hand, Trick said. But rather than rely solely on the computer to tell them something is wrong, there may be some advantages for hospitals to have their infection-control experts evaluate and interpret the data, he said.
"There might be benefits of a hybrid system in which both algorithmic and human interpretations are used," Trick said. The Joint Commission, a national nonprofit organization that accredits hospitals, has not taken a position on whether hospitals should adopt the technology, said Louise Kuhny, the commission's senior associate director for standards interpretation. "While good old infection-control data collection works, and what some people call 'shoe-leather epidemiology' has been used with success, there are some aids that can help infection-control practitioners," Kuhny said.
Computerized systems, she said, "should be considered a tool in data collection but they do not entirely replace (traditional) surveillance."
Hershey Medical Center has been using its computerized system, which cost about $268,000 to install and set up, for about 2 1/2 years, said Dr. Greg Caputo, the hospital's chief quality officer.
In the first year, the hospital saw the rate of reported infections increase dramatically because the system was capable of identifying "virtually all of the infections" in the hospital, Caputo said. Previously, the hospital's old system relied on samples of the patient population.
"Since that time, we've seen a gradual decrease in the overall rate of infection," Caputo said. Torregrossa is hopeful that hospitals that are reluctant to embrace the technology will eventually do so once they see the impact it has on reducing infection rates.
"We certainly are going to urge hospitals to use electronic surveillance systems," Torregrossa said. "We think their benefit has been proven."
Pa. hospitals go high-tech on infection tracking