Internal medicine: why three hospitals are using internal fax

Communications News, March, 1990 by Curt Harler

INTERNAL MEDICINE

One rule of hospital life states that a phone will ring unanswered just about the time the patients fall asleep.

Another says all elevators will be on the ninth floor when an important readout or prescription needs to be run from three to the basement.

Hospitals in Utah and Mississippi defied both rules by installing internal, as well as external, fax networks.

A lot of youngsters in Utah owe their lives to a hospital fax network--but even the babies' mothers don't know it.

Dr. Stephen Clark, a leading perinatologist, works with sick newborns and women in high-risk pregnancies. It would be impossible for him to cruise the 26 rural hospitals that are part of the Utah Valley Regional Medical Center around Provo.

Instead, physicians in outlying areas who are part of the Intermountain Healthcare System consult Dr. Clark by fax.

Electrocardiograms, fetal heart rate tracings, and other monitoring data go directly to the Perinatal Center 24 hours a day. Fetal heart tones are the main concern--Dr. Clark can determine how a baby is doing before birth and catch problems before an infant is faced with serious birth stress.

LDS Hospital, Salt Lake City, has a similar fax network that includes hospitals in northern Utah, Wyoming, and Idaho.

Glenn Doty calls the fax network at Greenwood Leflore Hospital "the best idea I ever had."

Popular Idea

If limitation is any measure, the rest of the hospital staff in Greenwood, Miss., agrees. The system, originally installed to speed prescription orders from nursing stations to the pharmacy, expanded to include outpatient, labor, and other wards.

The lab at the hospital plans to add 25 to 30 more machines early in April to form a laboratory network.

Jerry Ruffin, laboratory director, will connect the hospital with local medical offices. He says he expects to send X-rays and EKGs, as well as typical lab results, by fax.

The fax machines will replace the printer and dial-up modem system now in place. The hospital expects to pay the full cost of the network.

Delta Medical Center, Greenville, Miss., installed machines at all nursing stations, the pharmacy admissions office, burn center, cardiology, and emergency department to transmit prescription orders, lab and test results, and patient data.

The staff loves the idea.

Harold Blakely, the director of pharmacy at Delta, says he originally thought the big benefit would be keeping people from crowding into the already packed pharmacy.

"We didn't have the luxury of pneumatic tubes or order entry on the floor," he recalls. The old system called for runners to make hourly pickups at each nurses station. A prescription dropped off just after a runner left would mean another hour getting to the pharmacy and longer getting filled.

Greenwood Leflore Hospital formerly used a four-part physician's order form. It cost $10,000 a year for forms alone. Doty figures the original fax machines paid for themselves in 18 months, just on savings on forms.

All his machines are on auto-dial, although override is possible. Maintenance is no problem, since it is under contract. "It's cheaper and more reliable to contract to clean the mirrors once a month," Doty explains.

Fax machines generate a transaction report that gives time, date, time of transmission, and "OK." If the printout says cancel or line error, the fax is retransmitted.

Greenwood Leflore uses Sharp machines to transmit about 300 prescriptions daily.

The Utah Valley network uses Xerox, Sharp, and Canon faxes. All use Group III machines at 9600 baud.

Dr. Clark keeps two units, a Sharp and a Canon, in his home--one in office, one by his bed. "My wife is really happy about the fax by the bed" he says wryly.

Accuracy has been no problem. Generally, he advises outlying clinics to go with the low bid. "Anything as long as it has long document mode," Dr. Clark says.

Fetal heart rate tracings come out on strips 10 to 15 feet long. They are similar to an adult electrocardiogram.

Clinics also receive data on treatment from the Regional Center's library via fax. Some clinics use the fax as an in-office copier, too.

Social Services workers at Greenwood fax documents to other hospitals to get patients into extended care, for instance. It used to take three to four days by mail; now morning paperwork is approved by late afternoon and the patient is transferred the next day.

At Delta Medical Center, the network consists of Multifax Image Mates from Murata. Those machines have a document extender, too. The fax network runs through the hospital PBX and stays internal, although, outside calls can be made by using an access code.

Delta first leased faxes, then bought.

Blakely notes that prescriptions are not sent to drug stores in town, although he knows of no legal reason why they couldn't be.

Fax Is Hard Copy

Fading of faxed prescriptions is not a problem since orders are kept only until the patient is discharged. "If we need a hard copy, we photocopy the fax," he explains.

An added bonus is that the fax system spreads the orders out. "Rather than having a runner bring down a pile at once, we get them one at a time," Blakely says.