IT and Data Management in ER

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  • 1. IT and Data Management in the ER Nawanan Theera-Ampornpunt, MD, PhD Faculty of Medicine Ramathibodi Hospital
  • 2. Outline• Healthcare & Health IT• ER Information Needs• Information Systems in ER• Implications for Emergency Physicians
  • 3. Outline• Healthcare & Health IT• ER Information Needs• Information Systems in ER• Implications for Emergency Physicians
  • 4. Manufacturing Image Source: Guardian.co.uk
  • 5. BankingImage Source: Cablephet.com
  • 6. Health care ER - Image Source: nj.com
  • 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. Information is Everywhere in Health Care
  • 9. Health IT: What’s In A Word?Health GoalInformation Value- AddTechnology Tools
  • 10. Outline• Healthcare & Health IT• ER Information Needs• Information Systems in ER• Implications for Emergency Physicians
  • 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. 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. To Err Is Human• Example: Lack of Attention Image Source: aafp.org
  • 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. Outline• Healthcare & Health IT• ER Information Needs• Information Systems in ER• Implications for Emergency Physicians
  • 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. 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. Computerized Physician Order Entry (CPOE)
  • 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. 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. 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. Example of “Alerts & Reminders”
  • 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. Health Information Exchange (HIE) Government Hospital A Hospital B Clinic C Lab Patient at Home
  • 25. People-Process-Technology Technology People Process
  • 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. Unintended Consequences of Health ITSome risks• Alert fatigue
  • 28. Workarounds
  • 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. Outline• Healthcare & Health IT• ER Information Needs• Information Systems in ER• Implications for Emergency Physicians
  • 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. Questions?