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Hospitals offer a prescription for profit
30年来，威廉•内切斯医生(William Neches)总是先拿上病人病历和处方笺，然而开始他的例行巡视。
For 30 years Dr William Neches started his rounds by grabbing paper files and a prescription pad.
如今，他却推着一辆配有笔记本电脑和无线网卡的手推车，并用网卡登录进一个程序，该程序囊括了病人所有的临床信息，包括过去的治疗记录、CT扫描图像，以及各种检验结果。然后，他在线开出药方，通过网络从七楼的病区传送到地下室的内部药房。药房里有个机器人，会把方子上的药放进一个封袋，交给护士去发放。
Today, he takes a trolley with a laptop computer and a wireless network card and logs into a programme that contains all the clinical information on his patients, ranging from past treatments to CT scan images and various test results. He fills out his medication orders online and sends them from his ward on the seventh floor to the in-house pharmacy in the basement, where a robot puts the prescribed drugs in an envelope for the nurses to dispense.
“仍有一些指令无法通过该系统完成，比如化疗处方，但我们希望到2006年年中完全实现数字化。”内切斯大夫说。内切斯大夫今年64岁，是美国匹兹堡儿童医院（Children\'s Hospital of Pittsburg）的内科医师。
\"There are still some orders you can\'t do on the system, for example in chemotherapy, but by mid-2006 we want to be completely paperless,\" says Dr Neches, a 64-year-old physician at the Children\'s Hospital of Pittsburgh.
在这家拥有235张床位的医院实现数字化，成为由2000个电脑终端和85辆笔记本电脑手推车组成的数字网络中心，需要耗资900万美元。这是匹兹堡大学医疗中心(UPMC)为旗下20家医院发起的信息技术(IT)工程的一部分，该工程耗资5亿美元。
Transforming the 235-bed hospital into a digital hub with 2,000 computer terminals and 85 laptop trolleys cost $9m, and is part of a $500m IT project that the University of Pittsburgh Medical Center has launched for its 20 hospitals.
匹兹堡大学医疗中心的总裁兼首席执行官丹•德拉鲍(Dan Drawbaugh)确信，这些投资将得到回报。“我们预计，在5年的投资期中，我们每年将节省5000万美元成本，此后每年将节省1亿美元。”
Dan Drawbaugh, president and CEO of UPMC, is confident that the investment will pay off. \"We project savings of $50m per year during the five-year investment period and $100m in the years to follow,\" he says.
美国有近6000家医院是医疗新时代的范例，匹兹堡大学医疗中心是其中之一。虽然医疗保健机构对于是否完全实现数字化一直犹豫不决，但这种情况已开始转变。
UPMC is one of almost 6,000 hospitals in the US that act as showcases for a new era of medicine. While healthcare institutions have been reluctant to consider a fully digital environment, this is beginning to change.
迄今为止，这一转变主要在美国出现，但数字化医院无疑会在全球成为普遍现象。
The change has mainly been felt in the US so far, but the digital hospital is sure to become a worldwide phenomenon.
在英国，国民医疗保健服务系统(NHS)刚与IT供应商签署了为期10年、金额逾55亿英镑的合同，提供电子病历、电子预约、电子处方以及电子检测预约。这可能是全球最大的民用IT采购项目，将涵盖英格兰5000万病人和100万医务人员。该项目还会用数码影像来取代X光胶片，使远程病情诊断成为可能。
In the UK, the National Health Service has just signed 10-year contracts worth more than ?.5bn to provide electronic patient records, e-booking, e-prescribing and electronic ordering of tests, in what is arguably the world\'s biggest civil IT procurement - one that will cover all 50m patients in England and 1m staff. The programme should also see digital images replace x-ray film, making consultation on a patient\'s condition possible remotely.
但即便一切顺利，该系统最早也要到2008年才能投入运作。不过，伦敦中心区的大学学院医院(University College Hospital)将在明年完成数字化转变，成为全民医疗系统中首家真正实现数字化的医院。
Even if all goes smoothly, it will take until 2008 at the earliest for the system to be operational. But the first NHS hospital to become virtually paperless - University College Hospital in central London - will complete its transformation next year.
对于医疗技术产品销售商来说，数字医院的出现预示着一个新时代的来临。这些公司现已一致认为：提供最大商机的不再是独立设备，而是将设备联为一体的打包解决方案。
For companies that sell medical technology, the arrival of the digital hospital has signalled a new era. The consensus now is that the biggest business opportunities are no longer in stand-alone equipment, but packaged solutions that will network it into one unit.
这个市场可望形成巨大规模，无论是IBM、SAP、惠普(HP)和戴尔(Dell)等电脑巨人，还是堪萨斯城的Cerner和佛罗里达州的Eclipsis等利基式专门软件公司，都希望在其中分一杯羹。“这是下一件大事，”西门子医疗系统(Siemens Medical Systems)美国分部总裁兼首席执行官汤姆•迈考斯兰德(Tom McCausland)说。该公司是医疗保健技术方面的领军企业。
Computer giants such as International Business Machines, SAP, Hewlett-Packard and Dell, and niche software specialists such as Cerner of Kansas City and Eclipsis of Florida, all want a share of what is expected to be a very large market. \"This is the next big thing,\" says Tom McCausland, president and CEO of the US division of Siemens Medical Systems, a leader in healthcare technology.
“数字化从放射科和心脏病科开始，现已进入医院的各个领域，包括门诊预约，”通用电气医疗信息技术公司(General Electric Medical Systems Information Technologies)总裁兼首席执行官道•威尔逊(Dow Wilson)说。该公司总部位于威斯康星州。
\"It started in radiology and cardiology and has now moved into all areas of a hospital, including clinical orders,\" says Dow Wilson, president and CEO of General Electric Medical Systems Information Technologies, based in Wisconsin.
市场调查集团加特纳(Gartner)表示，医院数字化将成为硬件和软件公司的一个重要增长领域，预计到2006年，医疗保健业的IT支出将达479亿美元，年复合增长率为7%。
Gartner, the market research group, suggests that the digitisation of hospitals will become a significant growth area for hardware and software companies, and predicts that IT spending in healthcare will reach $47.9bn in 2006, with compound annual growth of 7 per cent.
相对医院来说，保健管理组织和保险公司的电脑化程度要高得多，因此，若不计它们的投资，医疗保健投资的增长率将达到可观的两位数。
Excluding investments by health management organisations and insurance companies, which are far more advanced in computerisation, the growth rate is a solid double-digit figure.
“我们正在关注一个增长率将达到约10%至20%的领域，”IBM商业咨询服务部(IBM Business Consulting Services)的医疗保健业主管尼尔•德•克雷申佐(Neil de Crescenzo)估计，“到目前为止，我们看到的仅仅是个开端。”
\"We are looking at an area where you will find about 10-20 per cent growth,\" estimates Neil de Crescenzo, healthcare industry leader at IBM Business Consulting Services. \"What we have seen so far is just the beginning.\"
就连布什(George W. Bush)总统也已表示，美国医疗机构实现数字化的时机已经成熟。在1月20日发表的国情咨文中，他提到医疗保健业即将面临变革，并提及数字化的优越性：“通过将医疗保健记录电脑化，我们可以避免危险的医疗过失，降低成本，并改善看护水平。”
Even President George W. Bush has signalled that the time is ripe for US medical institutions to go digital. In his State of the Union speech on January 20, he referred to the forthcoming changes in healthcare and mentioned the advantages of a digital environment: \"By computerising health rec- ords, we can avoid dangerous medical mistakes, reduce costs and improve care.\"
希望削减成本的不止他一个。美国的医疗保健支出迅速增长，难怪保险公司、医疗保健管理机构、各州及联邦政府都在努力削减支出。在它们所采取的策略中，创建数字化医院是个至关重要的部分。
He is not alone in wanting to cut costs. With spending on health in the US growing rapidly, it is not surprising that insurance companies, healthcare managers, US states and the federal government are all trying to reduce expenditure. Creating the digital hospital is a crucial part of their strategy.
“从长远来看，医院要想削减行政管理及人员成本，现在就必须在IT方面投入资金，”克雷申佐说。
\"Hospitals have to spend on IT now in order to cut costs in administration and personnel in the long term,\" argues Mr Crescenzo.
IT业人士认为，医疗机构需要有庞大的IT支出。过去，医疗机构一般只将收入的2.5%投入IT，而所有行业IT支出比例的平均值为3.95%，金融或电信等行业该比例高达12.5%。人们普遍认为，医疗机构IT支出比例低，主要原因是医疗行业竞争匮乏，长期投资管理状况欠佳，且医疗人员不愿从根本上改变工作方式。
The IT industry believes there is a lot of spending to do. Lack of competition, poor long-term investment management and a reluctance among medical staff to change fundamentally the way they work are widely stated as reasons why medical institutions have in the past typically spent only 2.5 per cent of their revenue on IT while the average of all industries was 3.9 per cent, and sectors such as finance or telecommunications up to 12.5 per cent.
迈考斯兰德先生指出，把医院网络化的技术已经存在“五、六年”了，但是，“可能由于相对在全球竞争的公司来说，医院简化工作流程的压力较小”，因此许多医院忽视了这种技术。他预计，新科技将“把医疗保健业的自动化水平提升到类似银行的标准”。
Mr McCausland pointed out that the technology to network hospitals had been available for \"five to six years\", but was ignored by many hospitals \"probably because there was less pressure to streamline the workflow than in companies that compete globally\". He expects new technology to \"bring healthcare up to automation standards of, let\'s say, banks\".
迄今为止，医疗保健IT行业还刚刚起步，即便在美国也是如此。“在美国所有的医院中，已完全采用电子病历的还不到2%，”卫生信息与管理系统协会(HIMSS)的电子保健业务开创部主管帕特•怀斯(Pat Wise)表示，“但40%的医院部分采用了电子系统，而且，考虑采用电子系统的医院比例越来越高。”卫生信息与管理系统协会是美国医院协会的附属机构。
So far, healthcare IT is a fledgling industry, even in the US. \"Less than 2 per cent of all American hospitals have fully implemented electronic medical records,\" says Pat Wise, director of the Electronic Healthcare Initiative at the Healthcare Information and Management Systems Society, an affiliate of the American Hospital Association. \"But 40 per cent have portions of such a system and an even larger percentage is considering it.\"
鉴于目前数字化医院仍然罕见，因此难以预估设立一个完全联网的环境共能节省多少成本。然而，一些医院（多数是小型专科诊所）率先实现了数字化。就它们的经历来看，这种技术的发展前景良好。
Given that digital hospitals are still a rare breed, it is hard to predict what the overall cost savings of a fully networked environment will be. However, the experiences of the pioneers - mostly small, highly specialised clinics - are promising.
内布拉斯加州心脏病医院(Nebraska Heart Hospital)于2002年5月实现数字化。据该项目的领先技术供应商西门子提供的数据，最初5个月中，该医院职工人数不变，仍是184个，而病人数从369人增至749人，几乎提高了一倍。
At Nebraska Heart Hospital, which went paperless in May 2002, the staff of 184 remained the same, but the number of patients almost doubled from 369 to 749 in the first five months, according to figures provided by Siemens, the project leader.
印第安那州心脏病医院(Indiana Heart Hospital)选择通用电气医疗解决方案部(General Electric Medical Solutions)作为其IT供应商，于2003年2月实现数字化。据威尔逊先生称，该措施可节省25%的成本，并将其医院员工人数从400人减至320人。
The Indiana Heart Hospital, which chose General Electric Medical Solutions as its IT provider and switched to a paperless environment in February 2003, could save 25 per cent of its costs and reduce its staff from 400 to 320, claims Mr Wilson.
节省成本的潜力十分诱人。但在内切斯博士看来，实现数字化还有其他好处。“我之所以对这种新系统充满热情，并非因为它能节省时间。事实上，要熟悉这种系统要花费大量时间。但是，它创造了目前可能具有的最安全的环境，”他说，“要知道，大多数医生的字迹都难以看懂，口述则可能导致灾难性的后果。”
The cost savings are potentially attractive. But for Dr Neches there are other benefits. \"The reason why I am so enthusiastic about the new system is not time-saving. Actually, it takes a hell a lot of time to get familiar with it. But it creates the safest environment currently possible,\" he says. \"You know, most physicians don\'t have particularly legible handwriting. Plus, a verbal order is a recipe for disaster.\"
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发表于 2004-2-25 00:00:00