Dr. Lluís Blanch

Senior Critical Care

Director of Research and Innovation

Corporació Sanitària Parc Taulí

President of SEMICYUC.

Member of the WFSICCM Council

Use of Information

Technologies in

Intensive Care

Antalya, November 13, 2014

L.Blanch is inventor of one Corporació Sanitaria Parc

Taulí owned US patent: “Method and system for

managed related patient parameters provided by a

monitoring device,” US Patent No. 12/538,940.

L.Blanch owns 10% of BetterCare S.L. which is a

research and development company, spin off of

Corporació Sanitària Parc Taulí.

Financial Disclosures

Lluis Blanch MD, PhD

ICU design: coordinated with other hospital units

and transport systems.

Halper NA

Chest 2014;145:399

The connectivity envelope includes hardware for

source tracking and data acquisition

Halper NA. Chest 2014;145:903

Advanced ICU Informatics:

AssociationPatients ID or patient location

InteroperabilityData generated by one device can be accessed

and used by another

Time SynchronizationVital for maintaining an electronic flow sheet and

tracking alarms and responses

Medical Devices are Informatics PlatformsIntegration with ICU middleware

Advanced ICU Informatics:

ICU Middleware

Electronic medical record

Alarm systems

Device servers

Smart displays

Telemedicine

Today

PICIS Critical Care Manager

CENTRICITY GE

IntelliSpace Critical Care and Anesthesia ICIP Philips

INNOVIAN de Draeger

INNOVIAN Dräger

MetaVision iMDsoft

ICU Computerized Information systems:

Advantages:-electronic chart

-import data of different devices

-nursing notes and events

-scores

-superior alerts and alarms

Limitations:-too much data, indicators

-safety: adverse events control

-data warehouse exploitation

-not integrated with HIS

Information overload

ICU ITs

Lack of Information !

PLOS ONE 2014;vol 9,e107930

Normal and abnormal

Laboratory Values

displayed by both

Interfaces subclassified

according to Gold

Standard Judgment:

“clinicians marked the

values about which

they would like to be

alerted”

Crit Care Med 2011; 39:34 –39

Potentially

injurious ventilator

settings for 1 h

during the first 3 d

of MV

Crit Care Med 2011; 39:34 –39

►

►►

JAMA Published online March 3, 2014

An alarm is efective when:

1. Activates when a serious problems develops

2. A clinician recognizes the alarm as being

indicative of said problem

3. The necessary know-how to address the

problem at hand exists

Murias G, Villagrá A, Blanch L. Minerva Anestesiol 2013;79:434-44

Ppl

Ppl

Paw

Paw

Increase

respiratory

effort

ASV PAV NAVA

SmartCare IntelVentVCV

PSV

PCV

Normal

respiratory

effort

Automation in MV

Lilly C et al. Crit Care Med. 2014 Nov;42(11):2429-36

ICU telemedicine programs:

• lower ICU (0.79; 95% CI, 0.65–0.96) and hospital mortality

(0.83; 95% CI, 0.73–0.94)

• shorter ICU (–0.62 d; 95% CI, –1.21 to –0.04 d) and hospital

(–1.26 d; 95% CI, –2.49 to –0.03 d) length of stay.

Claims Costs

Tomorrow

CCM 2013; 41:1502–1510

Physicians use a limited number of clinical information

concepts at the time of patient admission to the ICU. The

electronic medical record contains an abundance of

unused data.

Information

Overload in ICU

Reported frequency of utilization of data

elements in EMR

HR

SpO2

RR

MAP

Patient & Waveforms & Intelligence

ICU Middleware

ICU Middleware

Capture

Store

Remote

Review

# 36. 56 y. Severe ARDS. SAS 1. Days on MV 2

0 2 4 6 8 10 12 14 16 18 20 22 24 26 28

0

10

20

30

40

50

60

Asynchrony Index

Días en VM

% B

rth

s w

ith

Ala

rm in

1 h

ou

r

Asynchrony Index (AI)

MV Days

% breaths with

Asynchronies

(1 hour)

AI=SC+LC+DC+IEE

Machine & Patient Trigger breaths+IEE

50 patients on MV

82% of total time on

MV analyzed 6903

hours

Blanch L et al. Submitted

Blanch L et al. submitted

Asynchronies per hour & in representative patients

Asynchrony Index & Sedation Scale

Representative Patient

0 100 200 300 400 500 600 700 800 900 1000 11000

10

20

30

40

50

AI

SAS

Hour

Hours

AISAS

Hours

Discomfort

Dyspnea

- Air Hunger

- Work/Effort

- Tightness

Agitation

Risk of Extubation

Asynchrony

Report

?

Early Neurocognitive Rehabilitation in Intensive Care

Project funded by La Marató TV3 2010

Multidisciplinary Team

ENRIC at ClinicalTrials.Gov

Data-driven learning system

Celi LA et al. Am J Respir Crit Care Med 2013;187.1157-60

4Vs: value, volume, variety,

velocity

AJRCCM Articles in Press. Published on 28-July-2014

Obtaining information from various sources, often

with difficulty

PCP: pre-commercial procurement

PPI: public procurement of innovative solutions

To a vendor:

I need a pen

or

I need a device to write and …

Old Organization

+

New Technology

=

Costly Old Organization

Toll E. JAMA, June 20, 2012

physician artistfamily

When the physician saw the drawing, wrote: “The

economic stimulus bill has directed $20 billion to health

care information technology, largely funding electronic

medical record incentives. I wonder how much this

technology will really cost?”

The EMR should improve efficiency so that we have more

and not less time to communicate with our patients

Whatever automation or information

system, we need something real !!

Patient Team Science