© vanderbilt university 2008 inpatient clinical information systems, decision support, and analysis...
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© VANDERBILT UNIVERSITY 2008
Inpatient Clinical
Information Systems,
Decision Support,
and Analysis
Russ Waitman, PhD
Collaborators:
Asli Ozdas, PhD
Josh Peterson, MD, MPH
Jack Starmer, MD
Randolph Miller, MD
Department of Biomedical
Informatics
Vanderbilt University Medical
Center
OBJECTIVE:
Develop content driven Clinical
Information Systems that provide
rich decision support. Use clinical
information systems as a vehicle
for improving patient care in the
context of larger health care
process changes. Harvest and
analyze the resulting data to better
understand healthcare delivery,
disease processes, and optimize
therapy.
INTRODUCTIONVanderbilt University Medical Center has
accumulated a critical mass of inpatient clinical
information systems that can be used to influence
health care delivery and resulting data may
inform us about clinical processes. The
WizOrder/Horizon Clinicals team and its
collaborators design, operate, and analyze such
systems.
CURRENT SYSTEMS/RESOURCES
OTHER RESOURCES/SYSTEMSContent Management tools and databases
(orderables, ordersets, drug decision
support, advisors); Barcoded medication
administration (BCMA), AdminRx; Data mart
of order transactions, user keystroke logs,
lab results; CareOrganizer/STAT interfaces
PROJECTS1. Leverage improvements in microbiology
systems to enhance antimicrobial stewardship
2. Quantify the hospital’s medication
administration performance with BCMA data
3. Enhance medication reconciliation with
codification via RxNorm
4. Streamline discharge and transfer processes
5. Conduct knowledge discovery on inpatient
data linked to mortality by incorporating Social
Security Death Index data. Investigate newer
database technologies for clinical data mart.
6. Evaluate the impact of inpatient/outpatient
allergy integration
7. Enhance Alerting/Task list tools for nursing.
8. Continuous protocol evaluation: are nurse
managed heparin and insulin optimizing care?
9. Build systems to monitor drug decision
support effectiveness; build new approaches
that suggest personalized alternatives.
10. New sources for decision support: create a
Vital Signs Repository with q30second data and
integrate with perioperative systems
WizOrder/Horizon Expert
Orders
Horizon Expert Documentation
Adverse Drug Event
Surveillance
Medication Reconciliation
Medication Management Process Surveillance
Formulary, purchasing decisions
Inventory management
Dispense/distribute
medication
Obtain Medication-
related History
Document Medication
History
Diagnostic/ Therapeutic Decisions
Made
Medication Ordered
Evaluate orderSelect
medication
Educate patient
regardingmedication
Order verified and submitted
Prepare medication
Educate staff regarding
medications
History-Taking
Ordering
Pharmacy Management
Education
Select thecorrect drug for
the correctpatient
Administeraccording toorder and
standards fordrug
Documentadministrationand associated
information
Assess and document
patient response
to medicationaccording to
defined parameters
Intervene asindicated for
adversereaction/error
Administer MedicationMonitor/Evaluate Response Document
Medication Inventory Management
Administration Management
Monitoring and Surveillance
Surveillance
FCG, VHA Inc. after Bates et al. JAMA 1995
Kilbridge 2005
CPOE
HMM Pharmacy System
Bar code admin; eMAR; smart IV pumps, Discharge Med Reconcilation
Surveillance monitors all stages in Medication Management Process
Pre-admit Medication list
ConnectRx Carosel