Hargobind S. Khurana, MD, Robert H. Groves, MD, Michael P

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Real-Time Automated Sampling of Electronic Medical Records Predicts Hospital Mortality Hargobind S. Khurana, MD, Robert H. Groves, MD, Michael P. Simons, MD, Mary Martin, PharmD, Brenda Stoffer, RN, Sherri Kou, MS, Richard Gerkin, MD, Eric Reiman, MD, Sairam Parthasarathy, MD The American Journal of Medicine Volume 129, Issue 7, Pages 688-698.e2 (July 2016) DOI: 10.1016/j.amjmed.2016.02.037 Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 1 Organ dysfunction and systemic inflammatory response syndrome Decision Flowcharts (panel A) and systemic inflammatory response syndrome criteria (panel B) that were the basis of the Cerner-based SIRS/OD logic. This logic ran real-time in the Cerner data-warehouse and alerted the providers as shown in Figure 2. aPTT = activated partial thromboplastin time; Bili = serum bilirubin levels; CAM-ICU = Confusion Assessment Method in Intensive Care Unit patients; HR = heart rate; INR = international normalized ratio; LA = serum lactic acid levels; MAP = mean arterial pressure; O2 sat = oxygen saturation by pulseoximetry; PltCt = blood platelet count; RR = respiratory rate; SBP = systolic blood pressure; Scr = serum creatinine level; SIRS/OD = systemic inflammatory response syndrome and organ dysfunction; U/O = urine output charter in electronic medical record; WBC = white blood cell count. The American Journal of Medicine 2016 129, 688-698.e2DOI: (10.1016/j.amjmed.2016.02.037) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 1 Organ dysfunction and systemic inflammatory response syndrome Decision Flowcharts (panel A) and systemic inflammatory response syndrome criteria (panel B) that were the basis of the Cerner-based SIRS/OD logic. This logic ran real-time in the Cerner data-warehouse and alerted the providers as shown in Figure 2. aPTT = activated partial thromboplastin time; Bili = serum bilirubin levels; CAM-ICU = Confusion Assessment Method in Intensive Care Unit patients; HR = heart rate; INR = international normalized ratio; LA = serum lactic acid levels; MAP = mean arterial pressure; O2 sat = oxygen saturation by pulseoximetry; PltCt = blood platelet count; RR = respiratory rate; SBP = systolic blood pressure; Scr = serum creatinine level; SIRS/OD = systemic inflammatory response syndrome and organ dysfunction; U/O = urine output charter in electronic medical record; WBC = white blood cell count. The American Journal of Medicine 2016 129, 688-698.e2DOI: (10.1016/j.amjmed.2016.02.037) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 2 Schematic diagram of how the real-time electronic medical record-based alert would activate and inform the providers of severe sepsis and increased risk for death in their patients. Bili = serum bilirubin levels; CAM = Confusion Assessment Method; HR = heart rate; INR = international normalized ratio; MAP = mean arterial pressure; Plt Cnt = blood platelet count; RR = respiratory rate; SBP = systolic blood pressure; Scr = serum creatinine level; SIRS = systemic inflammatory response syndrome; WBC = white blood cell count. The American Journal of Medicine 2016 129, 688-698.e2DOI: (10.1016/j.amjmed.2016.02.037) Copyright © 2016 Elsevier Inc. Terms and Conditions

Figure 3 Kaplan-Meier curves across the electronic medical records (EMR)-based real-time alert during the hospital stay. The systemic inflammatory response syndrome and organ dysfunction-based EMR alert (SIRS/OD alert) triggered in hospitalized patients (green) or did not trigger (blue). The probability of survival was lower for patients with SIRS/OD alert trigger during their hospital stay than for patients without such an alert (P < .0001 by the log-rank test). The American Journal of Medicine 2016 129, 688-698.e2DOI: (10.1016/j.amjmed.2016.02.037) Copyright © 2016 Elsevier Inc. Terms and Conditions