IT and Data Management in the ER

Nawanan Theera-Ampornpunt, MD, PhDFaculty of Medicine Ramathibodi Hospital

Outline

• Healthcare & Health IT• ER Information Needs• Information Systems in ER• Implications for Emergency

Physicians

Outline

• Healthcare & Health IT• ER Information Needs• Information Systems in ER• Implications for Emergency

Physicians

Manufacturing

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Banking

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Health care

ER - Image Source: nj.com

• Life-or-Death• Many & varied stakeholders• Strong professional values• Evolving standards of care• Fragmented, poorly-coordinated systems• Large, ever-growing & changing body of

knowledge• High volume, low resources, little time

Why Health care Isn’t Like Any Others?

Information is Everywhere in Health Care

Health IT: What’s In A Word?

HealthInformationTechnology

Goal

Value-Add

Tools

Outline

• Healthcare & Health IT• ER Information Needs• Information Systems in ER• Implications for Emergency

Physicians

• Patient history– Problem list, comorbidities– Medication list– Previous visits

• Patient Safety– Allergies

• Treatment-Related– Drug interactions– Medical references– Lab & investigation results

• Patient Management– Progress tracking– Location tracking

ER Information Needs

• Limited available information• Often unreliable or incomplete• Unpredictable presentations• Urgency - Race against time• Importance of triage (separate signal from noise)• Crowded ER, poor operational efficiency

Problems with Information Management in ER

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• Example: Lack of Attention

To Err Is Human

• Guideline adherence• Better documentation• Practitioner decision making

or process of care• Medication safety• Patient surveillance &

monitoring• Patient education/reminder

Value of Health IT

Outline

• Healthcare & Health IT• ER Information Needs• Information Systems in ER• Implications for Emergency

Physicians

EHRs & HIS

Electronic Medical Records (EMRs)

Computer-Based Patient Records

(CPRs)

Electronic Patient Records (EPRs)

Electronic Health Records (EHRs)

Hospital Information

System (HIS)

Clinical Information

System (CIS)

• Computerized Medication Order Entry• Computerized Laboratory Order Entry• Computerized Laboratory Results• Physician Notes• Patient Demographics• Problem Lists• Medication Lists• Discharge Summaries• Diagnostic Test Results• Radiologic Reports

Functions that Should Be Part of EHR Systems

(IOM, 2003; Blumenthal et al, 2006)

Computerized Physician Order Entry (CPOE)

Values

• No handwriting!!!• Structured data entry: Completeness,

clarity, fewer mistakes (?)

• No transcription errors!• Entry point for CDSSs• Streamlines workflow, increases efficiency

Computerized Physician Order Entry (CPOE)

• The real place where most of the values of health IT can be achieved

– Expert systems• Based on artificial intelligence,

machine learning, rules, or statistics

• Examples: differential diagnoses, treatment options

Clinical Decision Support Systems (CDSSs)

– Alerts & reminders• Examples:

–Drug-allergy checks–Drug-drug interaction checks–Reminders for preventive services or

certain actions (e.g. smoking cessation)–Clinical practice guideline integration

Clinical Decision Support Systems (CDSSs)

Example of “Alerts & Reminders”

– Evidence-based knowledge sources e.g. drug database, literature

– Simple UI designed to help clinical decision making• E.g., Abnormal Lab Highlights

Clinical Decision Support Systems (CDSSs)

Health Information Exchange (HIE)

Hospital A Hospital B

Clinic C

Government

Lab Patient at Home

People-Process-Technology

Technology

ProcessPeople

Critical Success Factors in Health IT Projects

Theera-Ampornpunt (2011)

Communications of plans & progressesPhysician & non-physician user involvementAttention to workflow changesWell-executed project managementAdequate user trainingOrganizational learningOrganizational innovativeness

Some risks• Alert fatigue

Unintended Consequences of Health IT

Workarounds

– Alerts & reminders• Examples:

–Drug-allergy checks–Drug-drug interaction checks–Reminders for preventive services or

certain actions (e.g. smoking cessation)–Clinical practice guideline integration

Clinical Decision Support Systems (CDSSs)

Outline

• Healthcare & Health IT• ER Information Needs• Information Systems in ER• Implications for Emergency

Physicians

– ER has unique information needs– Health IT offers values to EP– Health IT has some risks (unintended

consequences)– The “right management” is a

critical success factor

Implications

Questions?