Patient safety
High-tech tools retain human touch
By Christine Cleary
In the future, Dana-Farber staff will scan bar codes on medications and match them with other aspects of patient care.
The small square of black-andwhite interlocking shapes on Gilbert Garber's wristband – a bar code that is his, and his alone – will one day allow a computer to link his medications, lab work, and electronic medical record. While the code will reduce the possibility of a medical error, it cannot begin to convey the essence of Garber, 82, and his family, who arrive at Dana-Farber for a checkup before his treatment for prostate cancer. "My doctor is named Appleman, and my nurse is named Appleby, so I call them Apple A and Apple B," he says, bearing gifts of apple cake.
In the next hour, Garber will encounter three high-tech innovations that illustrate Dana-Farber's leadership in using computerized information systems to enhance the quality, safety, and efficiency of adult care. From electronic medical records to bar codes, these are "organic" technologies, growing and changing daily to support the complex work of managing information about patients with cancer or related diseases.
Although computer technology is sometimes seen as a cold medium that requires people to interact with machines instead of one another, there is nothing chilly about the exchanges among Garber, his wife, Lillian, daughter Ronda Jacobson, and nurse practitioner Laurie Appleby, NP, as they sit together in an exam room with a flat-screen computer and printer. Appleby opens Garber's electronic medical record, and a complex history unfolds: prostate cancer spread to the bones, bypass heart surgery to clear five arteries, one failed kidney, and two replaced hips.
Everything is there, except those pieces of personal history stored in human memory, such as Garber's graduation from college at age 69, completing coursework that had been interrupted by service in World War II, and the family reunion he organized, attended in Israel by relatives from 12 countries.
Jacobson asks for a printout that shows the PSA levels in her father's blood, a marker for prostate cancer. "I think it was around 217, then dropped to 167," says Garber. "Yes, that's right," says Appleby, who hands over the sheet. "Any fevers? Sore throat? Painful feet?" She then logs Garber's answers in the computer.
At the end of the visit, Appleby enters the chemotherapy order into the computer, which feeds into the electronic medical record, to be read in the pharmacy. The family heads to the infusion unit for Garber's chemotherapy treatments.
