HL7 Clinical Laboratory Risk Engine Alerts in Hospitalized Patients

1. HL7 CLINICAL LABORATORY RISK ENGINE
ALERTS IN HOSPITALIZED PATIENTS
Dr. Humberto F. Mandirola Brieux
HL7 ARGENTINA, HOSPITAL ITALIANO de Buenos Aires,
HOSPITAL BELGRANO
16th International HL7 Interoperability Conference 2016
Genoa, June 13 - 15 2016
Humberto Fernán Mandirola Brieux abcd, Fernando Campos ab,
Diego Kaminker b, Sebastian Guillen c, Fernando La Rosab
6/12/2016 www.hl7.org.ar 1

2. •Introduction of the research.
•Background of Alert in hospitalized
patients in Critical Care Unit.
•Results.
•Conclusions
www.hl7.org.ar
AGENDA
6/12/2016
2

3. latitude 34°33'0.54"S
longitude 58°31'32.33"O
This study was conducted in the Belgrano Hospital
It is an acute Hospital of medium level
200 Beds
8 Critical care unit beds
250 Physicians
6/12/2016 www.hl7.org.ar 3

4. INTRODUCTION
•Focus on Abnormal Clinical
Laboratory risk values detection.
• An alert software was used.
•Clinical Laboratory risk often goes
unnoticed.
6/12/2016
www.hl7.org.ar 4

5. UNDETECTED CLINICAL
LABORATORY RISK PREVALENCE
•Undetected clinical laboratory risk values
is a serious concern.
•The prevalence of undetected clinical
laboratory risk values problems is higher
than believed.
•It’s a serious underestimated problem.
•The prevalence is 30%, out of which
50% goes undiagnosed.
6/12/2016
www.hl7.org.ar 5

6. Others underestimates subjects in
Hospitalized patient
•Alert Systems can help in issues like:
•Antibiotic therapy
•Allergies
•Nutrition Aspect
•Drug interactions
•Drug Contraindications
6

7. www.hl7.org.ar
Not sure how to deal with Undetected
abnormal Lab values?
Don't Bury your head in the Sand..
It seems obvious but it is not
6/12/2016 7

8. History Project
•Our aim to diminish the
undetected clinical lab risk value
rate.
•Clinical Laboratory risk aspects
assessed by doctors.
•Multidisciplinary approach.
•Creation of an automatic alarm.
6/12/2016
www.hl7.org.ar 8

9. THE ALERT ENGINE
•The alert engine was programed in C#.
•We used different standards.
•LOINC to laboratory data.
•ICD10 to medical record data.
•HL7 2.4 to transfer data.
6/12/2016
www.hl7.org.ar 9

10. THE INNER WORKING OF THE ALGORITHM
6/12/2016
www.hl7.org.ar 10

11. •
MEASURING THE EFFICACY
6/12/2016
www.hl7.org.ar 11

12. • Alert
group
Control
group
Both
groups
Total 150 150 300
Age max 93 90 93
Age min 34,5 22 22
Age average 67,34 66,00 67,05
SAMPLES
6/12/2016
www.hl7.org.ar 12

13. Inclusion & Exclusion Criteria
•This study is a randomized controlled trial, which provides
the most effective way to exclude external influences
between samples.
•We had to exclude eight patients in total, (3 from the
Alert group and 5 from the control group).
•We excluded these patients because some of these
patient’s data were missing, like laboratory results or
clinical data.
•After the exclusion of these patients, the total number of
patients of both groups was 292.
www.hl7.org.ar
6/12/2016
13

14. HOW THE ALERT ENGINE WORKS
Mirth Connect
6/12/2016
www.hl7.org.ar 14

15. RESULTS 1
Alert Control
Total 147 145
Undetected
clinical laboratory risk
100 115
Detected
clinical laboratory risk
47 30
6/12/2016
www.hl7.org.ar 15

16. RESULTS 2
6/12/2016
www.hl7.org.ar 16

17. CONCLUSION
•. Results have shown that the clinical
laboratory risk alert we built was of significant
help.
•Detection of clinical laboratory risk increased
by fourteen % in patients controlled with an
alarm system.
6/12/2016
www.hl7.org.ar 17

18. DISCUSION
•It is important to avoid
overabundance of alerts.
•Early detection of laboratory risk
plays a fundamental role in
reducing morbidity in patients.
6/12/2016
www.hl7.org.ar 18

19. Email me at hmandirola@biocom.com
Thank you
"Be the change you want to see in the world“
6/12/2016
www.hl7.org.ar 19