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:

Percent of time that doctors, while taking amedical history, fail to note in the record thepatients chief compliant

27%

Number of people at a hospital who need accessto a patient’s medical record at a given time 22%

Number of paper medical records that a quality-assurance staff can review per hour 3

Number of automated medical records that aquality-assurance staff can review per hour 400

Percent of patients’ visits during which a doctorcan’t get access to the patient’s medical record 30%

Percent of hospital patients’ paper records thatare incomplete 70%

Percent of laboratory tests that have to bereordered because the results aren’t in patients’records

11%

Percent of physicians’ time spent writing uppatients’ charts 38%

Percent of nurses’ time spent writing uppatients’ charts 50%

Weight of the average paper medical record (inlbs.) 1.5

Percent of time a diagnosis isn’t recorded in apatient’s record 40%

Flowsheet

Paper chartBaby

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

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

Primarychart

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