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Integrating Healthcare Information Technology (HIT) into
Clinical Practice
David K. Ahern, PhD, Thomas C. Bailey, MD, Charles B. Eaton MD, MS, David C. Goff, Jr, MD, PhD,
Jeffrey Rothschild, MD
For the Innovative Strategies Writing Group
Objectives
Illustrate approaches using information technology to improve adherence to guidelines
Identify selected barriers and facilitators for these approaches
List some of the preliminary lessons learned
Study Approaches Using HIT
CPOE-based decision support for inpatient transfusions
Transfusion CDS (Rothschild)
PDA-based decision support and academic detailing for cholesterol management
Guideline Adherence for Heart Health (Goff)
Waiting room patient activation software combined with PDA-based decision support for cholesterol management
CholesterolEducation AndResearchTrial (Eaton)
Automated ID of inpatient candidates for primary and secondary CHD prevention to facilitate academic detailing
TechnologyAssistedAcademicDetailing (Bailey)
Project descriptionProject
Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1:2-4.
TAAD, CEART, GLAD, T-CDS
CEART
Technology Assisted Academic Detailing (TAAD) Bailey et al
Automated identification of inpatient candidates for CHD prevention medications, coupled with pharmacist-mediated academic detailing to improve adherence to:
CHD secondary prevention guidelines for patients with AMI Cholesterol lowering guidelines for patients with diabetes
Patient identification using automated screening CHD/AMI – troponin-based screening DM – algorithm based on prior ICD-9, glucose, HA1c,
medications
Alert generated from patient data
Pharmacist approaches physicians with intervention
Pharmacist reviews alerts and evaluates for intervention
Barriers to TAAD Workflow issues
Timing of alert generation, response Short lengths of stay
Screening/alert to intervention time must be efficient
Personnel issues Prospective intervention requires personnel to
handle alerts
Facilitators of TAAD
IT infrastructure Flexibility to adapt to workflow Efficient methods of candidate identification Dedicated pharmacist resources Pre-existing pharmacist and physician culture High profile issues of recognized importance Both external and internal pressures to succeed
Lessons Learned from TAAD
Technical efficiencies make the impossible possible
Resource and workflow constraints are critical considerations
In asynchronous mode of decision support, must make sure physicians follow through
A pharmacist champion coupled with regular performance feedback is key
Pt activation tool
Cholesterol Education and Research Trial(CEART) Eaton, et al
PDA Decision Support Tool with Patient
Education Screen
Barriers to CEART & GLAD
Some patients were not technology oriented and wouldn’t use computer kiosk (CEART)
Varying physician experience with PDAs and technology for decision support
Physician workflow (and apparel) issues
Facilitators to CEART & GLAD
Design and development of tools based upon qualitative and formative research with patients and physicians
Training and reinforcement in use of tools Academic detailing regarding guidelines Inclusion of other software (e.g, ePocrates) Mobility and efficiency of PDA as a platform for
decision support tool Appeal and ease-of-use of patient activation tool
(CEART)
Lessons Learned from CEART & GLAD
Both patients and physicians need training and reinforcement in use of technology
Both technical and organizational challenges need to be addressed
Clinical decision support enabled by HIT requires integration with workflow
Questions
?