© 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