ICU Clinical Information Management System An Investigation for a Pediatric Intensive Care Unit Steven Sousa Ann Thompson

Background The patient record is a critical part of modern medical care Patient data is rarely consolidated in a format that supports good and efficient decision making As hospital care becomes more and more complex, the paper record becomes more and more inadequate

“Putting it on Paper” What efficiencies would be realized if a medical facility would go “paperless”? Here are some interesting numbers for you:

Flowsheet Paper chart Baby

The ICU Patient ICU patients have rapidly changing disease, often on a background of complex chronic disorders, with life-threatening dysfunction of one or more vital organ systems Patient management is increasingly complex Average patient undergoes laboratory tests per day, receives 5-15 different drugs, and 1-5 radiologic procedures

Those Involved Multiple physician specialists sub-specialists, nurses, respiratory therapists, pharmacists, and multiple other health professionals Diagnosis typically involves extensive laboratory testing as well as radiologic procedures. Treatment requires multiple pharmaceutical agents as well as extensive mechanical systems Frequent reassessment requires immediate access to new information

Nurse Respiratory therapist ECMO technicians Primary chart Bedside chart Kardex Respiratory chart

Children’s Hospital The Hospital is a 235 bed, private, independent, academic hospital affiliated with the University PICU complex is comprised of a 51 bed subset (20% of total beds) 2000 patients admitted a year Avg. length of stay is 6 days Total patients days is about 12,000

Current Situation Current PICU data management A Multiple paper charts for each patient B Manual transfer of data from monitors, labs, etc to flowsheet C Data analysis only by chart review Children’s Hospital information systems A Multiple systems specific to service (clinical laboratory, pharmacy, administration, etc) B New installation of integration engine (Datagate) C Limited ability to query any of the systems

Children’s Hospital Info. System

Desired Outcomes Integrate/Consolidate multiple paper charts and computerized databases Demographic data (ADT info) Integration with billing services Physiologic monitoring results Organ system support employed Laboratory, radiology, pathology testing results Pharmacy support (drug dosages, interactions, allergies, etc.)

Desired Outcomes (Cont’d) Kardex function Integration with care paths Outcomes data for regulatory bodies Capability to display variety of outputs Adaptability to PICU Medical narrative: progress notes Formatted v. free text (speech recognition) Searchable text

Vendors Analysis Eclipsys Ranking: 4.5 Cost: $1,499,000 + Clinicomp, International Ranking: 3.9 Cost: $ 989,750+ Agilent Technologies Ranking: (Incomplete) Cost: $1,238,497 +

Marketed Vendor Benefits Automates multidisciplinary documentation Establishes a “paperless record” Provides real-time access to data and decision support Minimizes duplicated data entry or potential handwriting errors Alerts users at the point of care of possible mistakes or errors Allows users to generate a complete audit trail

Marketed Vendor Benefits Interfaces to bedside instruments and monitors Integrates existing enterprise legacy systems Improves the continuity of care with patient care plans or clinical pathways Supports rapid information retrieval Supports clinical decision making

Eclipsys monitor screens

Gap Assessment Benchmarking Outcomes Comparison Trend Analysis Speech Recognition Security (lacking information on adequacy of current features Free Text Retrieval Primitive Decision Support Capability Image Capability User Acceptance

Recommendations Current systems would provide an electronic equivalent of the current paper record, probably with less missing data –Doubt FTE savings –Little support for reducing other costs

Recommendations New features (which include decision support, knowledge-based orders, data mining and analysis) are being developed rapidly –Reduc errors –Avoid redundancy –Improve compliance with care paths –Improve outcomes –Increase awareness of costs

Recommendations Send out new RFP focused on data analysis and decision support Delay purchase until this information is available