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Inpatient Clinical Information Systems, Decision Support, and Analysis. Medication Management Process Surveillance. Surveillance monitors all stages in Medication Management Process. History-Taking. Obtain Medication-related History. Document Medication History. - PowerPoint PPT Presentation
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© VANDERBILT UNIVERSITY 2008
Inpatient Clinical
Information Systems,
Decision Support,
and Analysis
Russ Waitman, PhDCollaborators:
Asli Ozdas, PhDJosh Peterson, MD, MPHJack Starmer, MDRandolph Miller, MDDepartment of Biomedical InformaticsVanderbilt University Medical CenterOBJECTIVE: 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 stewardship2. Quantify the hospital’s medication administration performance with BCMA data 3. Enhance medication reconciliation with codification via RxNorm4. Streamline discharge and transfer processes5. 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
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 1995Kilbridge 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