© 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. INTRODUCTION Vanderbilt 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/SYSTEMS Content 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 PROJECTS 1. 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 order Select medication Educate patient regarding medication Order verified and submitted Prepare medication Educate staff regarding medications History-Taking Ordering Pharmacy Management Education Select the correct drug for the correct patient Administer according to order and standards for drug Document administration and associated information Assess and document patient response to medication according to defined parameters Intervene as indicated for adverse reaction/error Administer Medication Monitor/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