Accurate Health Care at the Click of a Button

To err is human, but when one is working in the life-and-death environment of a hospital, a short lapse in attention or momentary carelessness can have tragic consequences. Now E&C Medical Intelligence, a Jerusalem-based software company, has released the IPROB (Intelligent Patient Record for Obstetrics), which has already saved lives and prevented serious medical errors. The device, so far designed for obstetrics departments in the U.S. whose specialists pay as much as $120,000 a year in medical negligence insurance, has been sold to major hospitals in the New York metropolitan area, Massachusetts and some areas in southern United States. However, E&C's founder, Dr Eyal Ephrat, says the software can be adapted to virtually any medical field and customized to suit any hospital department.

One example of the success of the IPROB system occurred at a Massachusetts hospital a few months ago. A nurse was told to give pitocin - a drug that induces labor - to a certain pregnant woman in the obstetrics ward. The nurse routinely entered the information in the IPROB computer at the patient's bedside, but to her surprise, the program refused to let her administer the infusion. Confused and alarmed, she went to a senior nurse who clicked the computer mouse to demand an explanation. It soon became clear that the patient was in her 26th week of pregnancy, suffering from premature contractions. The pitocin would have ended her precious pregnancy - a tragic and fatal mistake. An investigation into the cause of the confusion revealed that there had been a mix-up in patient names. .

Ephrat is a 41-year-old former kibbutznik who graduated from the Hebrew University-Hadassah Medical School in Jerusalem and worked as an obstetrician/gynecologist at Jerusalem's Sha'are Zedek Hospital. In 1995, he decided to cast away his white coat and embark on a new career: to found a high-tech company that would save lives and money by developing advanced computerized medical records and an active system to prevent errors. The company, headquartered in Jerusalem's Har Hotzvim Industrial Park, has a project implementation and customer support facility in Glen Rock, New Jersey, headed by gynecologist Dr. Bert Walls.

E&C now has more than 75 employees, 60 percent of them medical professionals (doctors, midwives and nurses), 30 percent engineering and support staff (software engineers, computer professionals and customer support specialists), and the rest sales and administrative staff.

"In the beginning, my family were particularly nervous," Ephrat recalls. "But now I would guess that many of my former colleagues envy me. Some 89,000 deaths of US patients each year are attributable to medical errors. The standard New York court settlement involving infants born defective or dying due to negligence is $10 million. E&C offers state-of-the-art technology, which can be adapted to suit anesthesiology and other hospital departments. The IPROB patient database includes 11,000 clinical data fields in a structured format for documenting every conceivable labor and delivery scenario, and takes into account more than 6,000 obstetrical rules."

Every time a patient is examined or tested, or before he or she is given medication or treated by a medical professional, the data is entered into his or her computerized medical file. Workstation terminals are located wherever a patient record needs to be used, including hospital wards, nurses' stations, operating theaters and triage rooms. Each doctor or nurse must enter a password to gain entry, and any data that has been added is stored permanently: it is impossible to erase or edit anything. Moreover doctors and nurses do not have to type long reports into the database. The system generates menus that cover specific clinical situations; all they need to do is click on the desired options.

A clicked item automatically produces a user-friendly description in the patient's summary within the file. IPROB also reminds doctors if they have failed to enter vital data: if they have done something contraindicated by accepted practice, they must enter a formal explanation for their actions. A top-ranked doctor working at one of E&C's fully operational sites commented, "It's like having my oldest, most trusted colleague standing over my shoulder and supporting my case management quality at every turn."

E&C has not applied for a US patent, because it is hard to protect software technologies for absolute uniqueness. But they are not afraid of theft of the individual systems, because each sold version is suited specifically to the medical institution or department where it is being used. "Each hospital has its own procedures and characteristics, so if somebody stole a IPROB and took it, say, to a hospital in Japan, he would have a system for operating the obstetrics department at Maimonides Hospital in Brooklyn, New York. It wouldn't help him. And it wouldn't pay for another software company to hire so many doctors to develop such a program by itself, while E&C continues to lead this niche."

Ephrat claims hospitals that bought the $1 million IPROB system "will get back their total investment within the first two years of system operation. Hospitals lose a great deal of money because their staff performs actions, gives medications and provides treatments which are not documented adequately because of time constraints. Because the hospitals can't prove the extent of care they provided, they often do not get properly reimbursed by the health maintenance organizations (HMOs). But with our computerized documentation of every little detail, they will get their money back." IPROB is also designed to automatically generate formal reports like birth certificates containing all the information required by the local health authorities, thereby creating considerable savings on clerical time. .

A doctor or nurse can learn to use the program effectively in only two hours. Although staffers may at first fear putting everything down into the record, Ephrat says they will actually learn to welcome this chore, as it will save them from making errors and protect them in the event of a lawsuit. "Medical negligence laws puts the burden of proof on the doctor. Our product provides this evidence."