When Gwen Allen's 60-year-old husband had a heart attack last month, she had no doubt where she wanted the ambulance to go. After all, she is a nurse at St Anthony Hospital in downtown Oklahoma City.
"Take him to the Oklahoma Heart Hospital," she told the driver.
Pharmacist Mickey Morrow lives in Ardmore, 100 miles outside Oklahoma City. He not only picked the Oklahoma Heart Hospital for his recent heart operation, but advises his pharmacy customers to go there instead of the alternatives closer at hand. Morrow enjoyed his time at the hospital so much that he logs on to its website to watch live surgery broadcasts. "I'm so fortunate to have lived long enough to see this technology at work," he says.
Enjoyment isn't something you associate with a hospital visit, especially an institution dedicated to diagnosing and fixing life-threatening heart conditions, but the Oklahoma Heart Hospital genuinely expects patients to enjoy their stay.
"We want to create a place where patients feel relaxed," says Jeff Jones, the hospital's lead system specialist. "Hospitals always had an egotistical attitude to dealing with the patient. They treat people like children. Stress is probably the number one cause of heart attacks, and if you bring people into a stressful situation, how are they going to get better?"
Opened in August 2002, OK Heart, as it is known to locals, was the first "digital hospital" in the world. There are still just a handful, most of which are in the US. In a digital hospital there are no paper records, no x-ray films and no storage room for patient files. If the paperless office has proved to be, in the words of one management consultant "about as likely as the paperless toilet", the paperless hospital is already with us. And the prescription is working: the hospital rates in the top 1% in the US for patient satisfaction.
At reception, 70-year-old Daisy Ulrich waits to be admitted. She needs treatment for the fluid on her chest and lungs but doesn't go to her local hospital in Norman, Oklahoma. "I don't like hospitals: if I had my way I wouldn't be here. But this is a marvellous place," she says.
From where she is sitting, it looks like any other hospital reception: sticky notes plastered on the monitor, an open diary and a giant map of the state inviting patients to stick a pin in their home town. But two metres behind the reception the paper trail abruptly stops: the first thing that patients do when they arrive is hand over their records for scanning.
Jones is the architect of the computer systems inside this $75m trailblazer, and says it is modelled on a five-star hotel. The building's technology automates every aspect of patient care: advising doctors on the most appropriate treatment, scheduling visits, making information available instantly anywhere in the hospital, from the operating theatre to the pharmacy.
On the first floor, groups of eight rooms are arranged in quiet pods around a nursing station, where nurses monitor vital signs on a bank of computer monitors. If a patient's heart rate rises or blood pressure spikes, an alarm sounds. If the monitoring software decides it is serious, then the nurses, wherever they are, automatically get a call or text message on their mobile phones. Press the button to call for a nurse and it is routed direct to his or her mobile.
This computer-based monitoring, Jones explains, is literally a lifesaver, because by automating the alert it removes the possibility of human error. "We have to accept that if you put people in a position to make a mistake, then sooner or later, they will," he says. "Five years ago, a hospital like this would have had a heart monitor by the bed, which sounds an alarm. It is amazing how many patients have died in hospital because their door was closed when the alarm went off."
OK Heart also has a novel way of cutting infection rates - patients are in and out of the hospital twice as fast as the national average, compressing care by cutting back the time patients spend waiting for test results and doctor visits. You don't go to the hospital to lie around so that a superbug can stumble across you.
"Five people can see the patient's record at the same time if that helps. In a paper world, they all take turns," says Peggy Tipton, the chief operating officer.
"You have a patient recovering from open heart surgery, and as a nurse you can sit at the bedside, call the doctor, order from the pharmacy, have it delivered and administer it, and still be holding the patient's hand. I have been in nursing 30 years and it doesn't get better than that."
When you finally get rid of the nurse, you find that your doctor has prescribed an educational video, delivered to the screen by your bed over the hospital computer network, telling you how to care for your pacemaker or change your diet.
However, it hasn't all been so easy. When the hospital was being built, Jones discovered that introducing technology was also increasing the possibility of infection. So doctors don't carry palmtop computers, because they transport infection as surely as a clipboard does today. There are no PCs in patient rooms, because the fans inside a computer recirculate infections in the air. The computers are all locked in a central room, with cables throughout the hospital connecting them to the bedside screens that doctors and nurses use. And every PC can access the same information - useful for the surgeons, who use the large monitors that dominate the operating theatres to catch up with email after hours.
There is a practical reason for using technology this aggressively: the longer you stay in hospital for the same treatment, the less chance you have of getting out of it alive. While the average stay for serious heart patients in the US is five days, the OK Heart average is 2.7 days, and falling. Doctors don't have to chase x-rays and MRI scans, which are in the patient's record before they get back to their room, and nurses don't chase the doctor's notes, which are transcribed remotely as soon as they are dictated.
It is a dramatic transformation in working practices: at the Indiana Heart Hospital, a digital hospital that runs along similar lines, internal research shows a reduction of 85% in medication errors, avoidable delays down by 65% and reductions in the cost of updating records by 45% compared with paper-based hospitals. Doctors also cut the time they spend updating records by a third.
And another thing British doctors may find surprising: at the Oklahoma Heart Hospital, there are no full-time administrators and no secretaries. Policy is set by doctors and nurses, and as a result it funds the highest number of nurses per patient in the US.
Infection rates are in the lowest 10% of hospitals in the US, but the real figure could be even better, as most hospitals simply don't have time to track most of their infections.
"In the old world, I would be at least one month behind in analysing charts of patients who had acquired an infection in the hospital, maybe even two months," says Cindy Miller, a nurse with 35 years experience who doubles as director of infection control.
"With our systems, every morning I can see every patient in the hospital who has a positive culture. On the same day, I can go back to our staff or the physicians and deal with it. I can look at 100 records in two hours. In my previous jobs, that would take me a week."
It is a world away from the struggles of Connecting for Health, the agency of the Department of Health that is spending £6.2bn over 10 years to computerise patient care in the UK. Because the US healthcare system treats individual hospitals as businesses, companies can create isolated centres of excellence, as in Oklahoma. In the UK, we are trying to bring every NHS hospital and GP surgery into the digital world at the same time. It is a much bigger bet, with much bigger risks and rewards.
The sort of patient care practised in Oklahoma and Indiana is a distant goal for the NHS, admits James Herbert, director of communications at Connecting for Health. "Such a big project is much more complicated," he says. "We admit we've struggled in some parts."
Back in Oklahoma, the patients are so enthusiastic you forget they are talking about times when they were close to death. You get the feeling that Mickey Morrow wouldn't mind a little more heart surgery. "When I was in the Heart Hospital, it didn't matter which doctor saw you. You know they had all your information," he says, "they didn't run around looking for things, or put you off. It was fascinating just to be in there."
- Visit the Oklahoma Heart Hospital website
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