Download ICU Clinical Information Management System

ICU Clinical Information
Management System
An Investigation for a Pediatric Intensive
Care Unit
Steven Sousa
Ann Thompson
Background
• The patient record is a critical part of
modern medical care
• Patient data is rarely consolidated in a
format that supports good and efficient
decision making
• As hospital care becomes more and more
complex, the paper record becomes more
and more inadequate
“Putting it on Paper”
• What efficiencies would be realized if a
medical facility would go “paperless”?
• Here are some interesting numbers for you:
Percent of time that doctors, while taking a
medical history, fail to note in the record the
patients chief compliant
Number of people at a hospital who need access
to a patient’s medical record at a given time
27%
22%
Number of paper medical records that a quality3
assurance staff can review per hour
Number of automated medical records that a
quality-assurance staff can review per hour
400
Percent of patients’ visits during which a doctor
can’t get access to the patient’s medical record 30%
Percent of hospital patients’ paper records that
are incomplete
70%
Percent of laboratory tests that have to be
reordered because the results aren’t in patients’
records
Percent of physicians’ time spent writing up
patients’ charts
Percent of nurses’ time spent writing up
patients’ charts
Weight of the average paper medical record (in
lbs.)
Percent of time a diagnosis isn’t recorded in a
patient’s record
11%
38%
50%
1.5
40%
Flowsheet
Baby
Paper chart
The ICU Patient
• ICU patients have rapidly changing disease, often
on a background of complex chronic disorders,
with life-threatening dysfunction of one or more
vital organ systems
• Patient management is increasingly complex
• Average patient undergoes 12-25 laboratory tests
per day, receives 5-15 different drugs, and 1-5
radiologic procedures
Those Involved
• Multiple physician specialists sub-specialists,
nurses, respiratory therapists, pharmacists, and
multiple other health professionals
• Diagnosis typically involves extensive laboratory
testing as well as radiologic procedures.
• Treatment requires multiple pharmaceutical agents
as well as extensive mechanical systems
• Frequent reassessment requires immediate access
to new information
Respiratory therapist
Respiratory
chart
ECMO
technicians
Nurse
Bedside chart
Primary
chart
Kardex
Children’s Hospital
• The Hospital is a 235 bed, private,
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independent, academic hospital affiliated
with the University
PICU complex is comprised of a 51 bed
subset (20% of total beds)
2000 patients admitted a year
Avg. length of stay is 6 days
Total patients days is about 12,000
Current Situation
• Current PICU data management
• A Multiple paper charts for each patient
• B Manual transfer of data from monitors, labs, etc to
flowsheet
• C Data analysis only by chart review
• Children’s Hospital information systems
• A Multiple systems specific to service (clinical
laboratory, pharmacy, administration, etc)
• B New installation of integration engine (Datagate)
• C Limited ability to query any of the systems
Children’s Hospital Info. System
Hospital Information Systems
ADT
(SMS InVision)
Pathology
(CoPath)
Laboratory
(Sunquest)
Radiology
(APAQ)
DATAGATE
ICU
Electronic
Medical
Record
Pharmacy
(Pharmnet)
Individual system
Integration engine
(translator)
Proposed PICU EMR
Desired Outcomes
• Integrate/Consolidate multiple paper charts and
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computerized databases
Demographic data (ADT info)
Integration with billing services
Physiologic monitoring results
Organ system support employed
Laboratory, radiology, pathology testing results
Pharmacy support (drug dosages, interactions,
allergies, etc.)
Desired Outcomes (Cont’d)
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Kardex function
Integration with care paths
Outcomes data for regulatory bodies
Capability to display variety of outputs
Adaptability to PICU
Medical narrative: progress notes
• Formatted v. free text (speech recognition)
• Searchable text
Vendors Analysis
• Eclipsys
• Ranking: 4.5
• Cost: $1,499,000 +
• Clinicomp, International
• Ranking: 3.9
• Cost: $ 989,750+
• Agilent Technologies
• Ranking: (Incomplete)
• Cost: $1,238,497 +
Marketed Vendor Benefits
• Automates multidisciplinary documentation
• Establishes a “paperless record”
• Provides real-time access to data and decision
support
• Minimizes duplicated data entry or potential
handwriting errors
• Alerts users at the point of care of possible
mistakes or errors
• Allows users to generate a complete audit trail
Marketed Vendor Benefits
• Interfaces to bedside instruments and
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monitors
Integrates existing enterprise legacy
systems
Improves the continuity of care with patient
care plans or clinical pathways
Supports rapid information retrieval
Supports clinical decision making
Eclipsys monitor
screens
Gap Assessment
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Benchmarking
Outcomes Comparison
Trend Analysis
Speech Recognition
Security (lacking information on adequacy of
current features
Free Text Retrieval
Primitive Decision Support Capability
Image Capability
User Acceptance
Recommendations
• Current systems would provide an
electronic equivalent of the current paper
record, probably with less missing data
– Doubt FTE savings
– Little support for reducing other costs
Recommendations
• New features (which include decision
support, knowledge-based orders, data
mining and analysis) are being developed
rapidly
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Reduc errors
Avoid redundancy
Improve compliance with care paths
Improve outcomes
Increase awareness of costs
Recommendations
• Send out new RFP focused on data analysis
and decision support
• Delay purchase until this information is
available