It is a deadly serious trust - even for Kimball, an assistant professor of surgery teaching a new generation of physicians.
"These people are sometimes so close to the edge that having that antibiotic in their veins, even two or three hours sooner, makes the difference between living or dying," he says.
Tens of thousands die every year in the nation's hospitals because of medical error: The Institute of Medicine put the toll at 98,000 in a 1999 study, while a national HealthGrades Inc. survey released earlier this year estimated 195,000.
But a new breed of intelligent software made by Salt Lake City's own TheraDoc Inc. is giving doctors the gift of time - and ready access to critical information.
University Hospital is among a dozen either now using or about to add the company's technology, which combines the convenience of laptop and hand-held computers with on-demand access to mountains of constantly changing medical data.
At each bed he visits, Kimball may have mere minutes to integrate multiple staff observations, imaging scans, blood and fluid work-ups, medications and a patient's possible allergies to them in order to take the next step in treatment.
"Before [TheraDoc], I would have to gather results from radiology, blood work, microbiology cultures and infectious disease and medication information from multiple different sources."
Such delays might be as little as 15 minutes, or as much as 15 hours. Even then, reports would be out of date.
"For patients very sick, that's hours for an infection to set up house and take over defense mechanisms," Kimball says.
Now? The doctor and his entourage of student surgeons make rounds with a tablet PC connected wirelessly to the hospital's wireless network and high-speed Internet systems. For each patient, records pop up on the screen with up-to-date data gathered from nurses, lab technicians, pharmacists, X-ray, MRI and CT scans - and more.
The TheraDoc software also makes recommendations on medication uses and dosage levels - warning doctors about possible drug interactions and allergic reactions. Links to the latest medical research are also seamlessly tied in, accessible with the click of a mouse.
A more recent addition is a Web-based connection to infectious disease information. TheraDoc monitors its patient database for such ailments as West Nile virus, SARS, anthrax exposure, staph, pneumonia and hepatitis.
When the program finds such instances, it instantly notifies caregivers and can notify state health departments and the Centers for Disease Control as well, generating the appropriate reports for each agency.
Based on data similarly gathered from state, regional and national medical databases, TheraDoc's Antibiotic Assistant application then can recommend up-to-date treatments.
Teresa Nowalk, infection control nurse at Great Plains Regional Medical Center in North Platte, Neb., was impressed with the software's "real-time reporting," which she says resulted in significant improvements in controlling and reducing infections.
"In the past I had to manually analyze information a month or two behind," Nowalk says.
An earlier version of TheraDoc infection control technology was part of the ALERT database that monitored athletes' health during Salt Lake City's 2002 Winter Olympic Games.
Since then, the 5-year-old company has attracted a number of medical facilities to its ranks.
"We were just approved to sell our software applications to the Veterans Administration's 170-some hospitals," says Stanley Pestotnik, TheraDoc's president and chief executive.
"Our software tells the physician the five Ws - who I need to look at, what I need to look at, what I need to do, why I should do it, and finally, what I need to document," he adds.
The company also has made deals with Johns Hopkins, Northwestern's Memorial Hospital, France's bioMerieux Inc. and UC-Davis Health Systems. Terms of the contracts were not disclosed.
Privately held TheraDoc does not release financial performance data, though Pestotnik says the 40-employee enterprise is "cash-flow positive."
Thomas Tinstman, associate director of clinical information systems at the University of California at Davis, sees TheraDoc as an example of how "sophisticated software programs and information technology are revolutionizing the practice of medicine.
"Electronically maintaining all patient records and clinical data in a single, secure system [gives doctors the means] to help improve the quality of care and patient safety," he said.
What TheraDoc, even with all its technological bells and whistles, does not do is replace doctors.
"These are decision-support tools, but they will never replace the physician," Pestotnik says. TheraDoc "can mean shorter hospital stays and faster treatment, though, with the cost of treatments dramatically reduced."
Kimball agrees, saying he will take all the help he can get.
"Medical information turns over 50 percent every five years," he says. "There's no way an individual with 20 critically ill patients can be aware of all that stuff . . . but this way, I can keep abreast of the latest in the journals and clinical care."
bmims@sltrib.com
