Evaluation of Clinical Information Technology

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Evaluation of Clinical Information Technology
Sutter Health Institute for Research Education
(SHIRE)

• CLC 11/17/04
• Jeff Newman MD MPH

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Information for Action

• Health services research linked with
• clinical IT
• quality improvement
• community benefit

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• Our Products
• Reports
• Papers
• Proposals
• Selected investigator initiated projects
• Patient decision making for prostate ca
• Palliative care

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Data Sources

• Quantitative
• Administrative e.g. mortality, LOS, financial
• IT vendor reports
• Primary data collection
• -Selected medical record reviews
• -Surveys
• Qualitative
• Interviews
• Focus groups

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Enterprise Data Store
Data Store
Organized By
Claims
FinanceHR.. Payroll..
Subject Matters
Create
BAR
Utilization
Staffing
Products
Consists Of
Data Cubes
Data Marts
Standard Reports
Standard Data Definitions
Product Workshop Training
Product Components
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Objectives

• Describe eMAP and eICU structure, process, and
  outcome measures
• Identify opportunities to improve
• Anticipate evaluation of EMR

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eMAP Methods

• Reports audited at 6 affiliates to confirm
  prevented observed errors
• MD, RN, and PharmD panel
• (blinded to prevented / observed) rated cases
  for potential clinical significance

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Medication Administration Errors By Type
Observed (2.8)
Prevented (1.1 of Total Attempted )
Dose Early or Already Given
Order Discontinued or Expired
Dose Early or Already Given
47
13
35
No Order in System
21
No Order in System or No Active Order
Wrong Dose
27
26
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Potential Clinical Significance of
Prevented Errors
Observed Errors
8
1
9
1
Minimal
Moderate
Severe
91
90
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Outcomes for 1,000,000Attempted Administrations
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eMAP Inputs for Optimization

• Physician Rx - dialogue with pharmacy on order
  writing practices
• Avoid interval range orders
• Pharmacy Database
• Allergies
• (Labs)
• Settings max dose grace period
• Report filters - Focus on high impact errors
• Wrong patient
• High-risk drugs, e.g. coumadin, insulin

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Benefits of Electronic Medication Administration
Record

• Real time information
• Legible and unalterable charting
• Physician access to all inpatient drug profiles
  from any unit, the lounge and medical records
• Fast access at the bedside

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The Importance of eICU Alignment
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eICU Components
ICU
eICU
Tele-monitoring
eCare Manager
Smart Alerts
Smart Reports
Organization for QI
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Increase in ICU Treatments
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eICU Outcome Measures

• Mortality
• (Complicated by advanced directives)
• Complications, e.g. sepsis
• Length of stay
• (Complicated by disposition problems)
• Risk adjustment using Apache

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eICU Optimization Activities

• Initiate SH-wide ICU clinician network
• Extract clinical data from eCareManager
• allow confirmation of Smart Reports
• evaluation analyses, e.g. stratify process
  outcomes by delegation
• More decision support, e.g. alerts for
  recommended treatments

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General Recommendations for Clinical IT

• More involvement of clinical stakeholders in
  design evaluation
• Maximize decision support
• Establish communities of practice
• Build in analytic databases
• Link with other databases (SHEW) pharmacy, lab,
  diagnostic

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Types of Innovation Adopters and EMR Users
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Achieving Acceptance of Clinical IT

• Innovators restraint may be required
• Early adopters education on benefits
• Early majority education motivation
• Late majority add peer pressure identification
  of barriers
• Laggards remove barriers, train support