ICU Clinical Information Management System

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ICU Clinical Information Management System

• An Investigation for a Pediatric Intensive Care
  Unit
• Steven Sousa
• Ann Thompson

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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

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Putting it on Paper

• What efficiencies would be realized if a medical
  facility would go paperless?
• Here are some interesting numbers for you

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Flowsheet
Baby
Paper chart
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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 12-25 laboratory tests
  per day, receives 5-15 different drugs, and 1-5
  radiologic procedures

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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

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

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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
• Childrens 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

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Childrens Hospital Info. System
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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.)

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Desired Outcomes (Contd)

• 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

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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

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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

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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

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Eclipsys monitor screens
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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

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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

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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

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Recommendations

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