IT and Data Management in ER

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IT and Data Management in ER

  1. 1. IT and Data Management in the ER Nawanan Theera-Ampornpunt, MD, PhD Faculty of Medicine Ramathibodi Hospital
  2. 2. Outline• Healthcare & Health IT• ER Information Needs• Information Systems in ER• Implications for Emergency Physicians
  3. 3. Outline• Healthcare & Health IT• ER Information Needs• Information Systems in ER• Implications for Emergency Physicians
  4. 4. Manufacturing Image Source: Guardian.co.uk
  5. 5. BankingImage Source: Cablephet.com
  6. 6. Health care ER - Image Source: nj.com
  7. 7. Why Health care Isn’t Like Any Others?• Life-or-Death• Many & varied stakeholders• Strong professional values• Evolving standards of care• Fragmented, poorly-coordinated systems• Large, ever-growing & changing body of knowledge• High volume, low resources, little time
  8. 8. Information is Everywhere in Health Care
  9. 9. Health IT: What’s In A Word?Health GoalInformation Value- AddTechnology Tools
  10. 10. Outline• Healthcare & Health IT• ER Information Needs• Information Systems in ER• Implications for Emergency Physicians
  11. 11. ER Information Needs• Patient history – Problem list, comorbidities – Medication list – Previous visits• Patient Safety – Allergies• Treatment-Related – Drug interactions – Medical references – Lab & investigation results• Patient Management – Progress tracking – Location tracking
  12. 12. Problems with Information Management in ER• Limited available information• Often unreliable or incomplete• Unpredictable presentations• Urgency - Race against time• Importance of triage (separate signal from noise)• Crowded ER, poor operational efficiency
  13. 13. To Err Is Human• Example: Lack of Attention Image Source: aafp.org
  14. 14. Value of Health IT• Guideline adherence• Better documentation• Practitioner decision making or process of care• Medication safety• Patient surveillance & monitoring• Patient education/reminder
  15. 15. Outline• Healthcare & Health IT• ER Information Needs• Information Systems in ER• Implications for Emergency Physicians
  16. 16. EHRs & HISElectronic HealthRecords (EHRs) Hospital InformationElectronic Medical System (HIS) Records (EMRs)Electronic Patient Records (EPRs) Clinical InformationComputer-Based System (CIS)Patient Records (CPRs)
  17. 17. Functions that Should Be Part of EHR Systems • Computerized Medication Order Entry • Computerized Laboratory Order Entry • Computerized Laboratory Results • Physician Notes • Patient Demographics • Problem Lists • Medication Lists • Discharge Summaries • Diagnostic Test Results • Radiologic Reports (IOM, 2003; Blumenthal et al, 2006)
  18. 18. Computerized Physician Order Entry (CPOE)
  19. 19. Computerized Physician Order Entry (CPOE) Values • No handwriting!!! • Structured data entry: Completeness, clarity, fewer mistakes (?) • No transcription errors! • Entry point for CDSSs • Streamlines workflow, increases efficiency
  20. 20. Clinical Decision Support Systems (CDSSs) • The real place where most of the values of health IT can be achieved – Expert systems • Based on artificial intelligence, machine learning, rules, or statistics • Examples: differential diagnoses, treatment options
  21. 21. Clinical Decision Support Systems (CDSSs)– Alerts & reminders • Examples: –Drug-allergy checks –Drug-drug interaction checks –Reminders for preventive services or certain actions (e.g. smoking cessation) –Clinical practice guideline integration
  22. 22. Example of “Alerts & Reminders”
  23. 23. Clinical Decision Support Systems (CDSSs)– Evidence-based knowledge sources e.g. drug database, literature– Simple UI designed to help clinical decision making • E.g., Abnormal Lab Highlights
  24. 24. Health Information Exchange (HIE) Government Hospital A Hospital B Clinic C Lab Patient at Home
  25. 25. People-Process-Technology Technology People Process
  26. 26. Critical Success Factors in Health IT ProjectsCommunications of plans & progressesPhysician & non-physician user involvementAttention to workflow changesWell-executed project managementAdequate user trainingOrganizational learningOrganizational innovativeness Theera-Ampornpunt (2011)
  27. 27. Unintended Consequences of Health ITSome risks• Alert fatigue
  28. 28. Workarounds
  29. 29. Clinical Decision Support Systems (CDSSs)– Alerts & reminders • Examples: –Drug-allergy checks –Drug-drug interaction checks –Reminders for preventive services or certain actions (e.g. smoking cessation) –Clinical practice guideline integration
  30. 30. Outline• Healthcare & Health IT• ER Information Needs• Information Systems in ER• Implications for Emergency Physicians
  31. 31. Implications– ER has unique information needs– Health IT offers values to EP– Health IT has some risks (unintended consequences)– The “right management” is a critical success factor
  32. 32. Questions?

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