Evaluation of Clinical Information Technology

1. Sutter Health Institute for Research & Education (SHIRE) Evaluation of Clinical Information Technology CLC 11/17/04 Jeff Newman MD MPH

2. Information for Action Health services research linked with: • clinical IT • quality improvement • community benefit

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

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

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

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

10. 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

11. 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% No Order in System 35% 21% No Order in System or No Active Order Wrong Dose 27% 26%

12. Potential Clinical Significance of: Prevented Errors Observed Errors 8% 1% 9% 1% Minimal Moderate Severe 91% 90%

13. Outcomes for 1,000,000Attempted Administrations

14. 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

15. 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

16. The Importance of eICU Alignment

17. eICU Components ICU eICU Tele-monitoring eCare Manager Smart Reports Smart Alerts Organization for QI

18. Increase in ICU Treatments

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

20. 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

21. 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

22. Type of Innovation Adopters Innovators Early Adopters Laggards Late Majority Early Majority Non-adopters EMR adopters Type of EMR Users System Changers Arrivers Viewers Basic Users Strivers Types of Innovation Adopters and EMR Users

23. 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