MedCentral Health System Using Artificial Intelligence Software as a Clinical Decision Support Tool for Laboratory Results: First Increased Troponin – I Alert Project Fred Crowgey, MBA, M(ASCP), Karen Phalor, MT (ASCP), Eugenio Zabaleta, PhD, J Burgess, MD, M. Patterson, DO, CMIO

MedCentral Health System 18,000 admissions 9,000 surgeries 70,000 emergency visits 300,000 outpatient visits 1,400,000 lab tests 160,000 radiology procedures 380 open heart surgeries

MedCentral Health System In 2007, the medical staff at MedCentral Health System expressed the need for both the laboratory to identify clinically significant cardiac Troponin results and a system to relay that information to the care provider in a timely fashion. Even though human communication has historically been the cornerstone of patient care, it can be enhanced by IT.

Troponin I

Proposed Solution: MedCentral would/has incorporated the Decision Tool – PKS RippleDown®/LabWizard® - supplied by Pacific Knowledge Systems into the MedCentral Enterprise Information System (EIS). Within RippleDown®, specific rules were constructed for the purpose of providing clinically relevant alerts based on the outcome of current and previous testing for each patient to warn physicians of potential issues with their inpatients. Consistent application of clinical knowledge through RippleDown® eliminates "human errors".

Actions Within PKS RippleDown®, specific rules were constructed for the purpose of providing clinically relevant alerts based on the outcome of current and previous lab tests. Configured LIS for “Interfaces” and alerts. Stored Procedures for OpenLink Integration Engine. Consistent application of clinical knowledge through IT eliminates "human errors".

IT Design Outcome Design: or Process MedCentral Laboratory is able to identify the First increase in Troponin-I above the WHO (World Health Organization) cut off (0.780 ng/mL) When the first increase of Troponin-I occurs RippleDown® will send an alert message to the lab information system (NOVIUS). The performing lab professional then will call the clinician for that patient and communicate the increase of Troponin-I. The nurse will then phone the physician. The results will also be communicated to the attending or consulting physician through SOARIAN Clinicals in the Alert section through Rules and Workflow software.

Lab Result Result Reviewed By Rules Engine Result Posted Alert Posted T Test Performed Tech Notified to call clinician (LIS) (CDR) Test Ordered

Rippledown ® Overview Decision support software which works on “cases” Rules built by clinical staff, not IT Pathologists/clinicians/researchers (users) able to: – create and maintain their own Knowledge Bases – implement their own interpretation of evidence based guidelines – implement their local reporting preferences – control their own workflow Considers historical data and trends Rules can access all relevant data – Past test results – Clinical data – Patient and doctor demographics – Previous report comments

Results MedCentral laboratory has performed 1618 Troponin-I tests in the inpatient population on the month of April 2010, 53 of them were classified as a first Troponin-I increase by RippleDown®. Data was gathered from NOVIUS® Lab, Soarian® Clinicals, Rules and Workflow engine and RippleDown® to analyze the implementation of the Troponin-I Alert Project and its clinical impact. There is sufficient documentation showing that from the 53 phone calls to the physicians due to Troponin-I increase, 25 generated new treatment orders at the time of the call.

Conclusion In conclusion, there is enough documented data that the First Increased Troponin-I Alert Project is improving communication of information without replacing the critical thinking or decision making of the patient care providers or adding unnecessary phone calls. Further clinical outcomes remain to be seen.

Keys Point – No human intervention to generate alerts. – System runs 24/7/365 – Process generates a phone call to appropriate clinician

Pilot Tests Troponin Chem 8 Delta checks (Gluc, BUN, Creatinine, Calcium, Na, K, Cl, and CO2)— Identify clinical shifts in analytes H & H— WBC Lipid Profiles

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