1. SHIRE Evaluation of Clinical Information Technology CLC 11/17/04 Jeff Newman MD MPH Sutter Health Institute for Research & Education (SHIRE)

2. SHIRE Information for Action Health services research linked with: clinical IT quality improvement community benefit

3. SHIRE Our Products: Reports Papers Proposals Selected investigator initiated projects: Patient decision making for prostate ca Palliative care

4. SHIRE Data Sources Quantitative Administrative e.g. mortality, LOS, financial IT vendor reports Primary data collection -Selected medical record reviews -Surveys Qualitative Interviews Focus groups

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6. Claims BAR Data Cubes Finance……HR….. Payroll….. UtilizationStaffing Data Marts Standard Reports Standard Data Definitions Product Workshop Training Data Store Subject Matters Products Product Components Organized By Consists Of Create Enterprise Data Store

7. SHIRE Objectives Describe eMAP and eICU structure, process, and outcome measures Identify opportunities to improve Anticipate evaluation of EMR

8. SHIRE

10. eMAP Methods Reports audited at 6 affiliates to confirm prevented & observed errors MD, RN, and PharmD panel (blinded to prevented / observed) rated cases for potential clinical significance

11. SHIRE Medication Administration Errors By Type Prevented (1.1% of Total Attempted ) No Order in System or No Active Order 27% Dose Early or Already Given 47% Order Discontinued or Expired 13% Observed (2.8%) Dose Early or Already Given 35% Wrong Dose 26% No Order in System 21%

12. SHIRE Potential Clinical Significance of: Prevented Errors 91% 8%1% Observed Errors 90% 9%1% Minimal Moderate Severe

13. SHIRE Outcomes for 1,000,000 Attempted Administrations

14. SHIRE eMAP Inputs for Optimization Physician Rx - dialogue with pharmacy on order writing practices Avoid interval range orders Pharmacy Database Allergies (Labs) Settings: max dose & grace period Report filters - Focus on high impact errors Wrong patient High-risk drugs, e.g. coumadin, insulin

15. SHIRE Benefits of Electronic Medication Administration Record Real time information Legible and unalterable charting Physician access to all inpatient drug profiles from any unit, the lounge and medical records Fast access at the bedside

16. SHIRE The Importance of eICU Alignment

17. SHIRE eICU Components eCare Manager Smart Alerts ICU eICU Smart Reports Tele-monitoring Organization for QI

18. SHIRE Increase in ICU Treatments

19. SHIRE eICU Outcome Measures Mortality (Complicated by advanced directives) Complications, e.g. sepsis Length of stay (Complicated by disposition problems ) Risk adjustment using Apache

20. SHIRE eICU Optimization Activities Initiate SH-wide ICU clinician network Extract clinical data from eCareManager allow confirmation of Smart Reports evaluation analyses, e.g. stratify process & outcomes by delegation More decision support, e.g. alerts for recommended treatments

21. SHIRE General Recommendations for Clinical IT More involvement of clinical stakeholders in design & evaluation Maximize decision support Establish “communities of practice” Build in analytic databases Link with other databases (SHEW): pharmacy, lab, diagnostic

22. SHIRE Types of Innovation Adopters and EMR Users Type of Innovation Adopters LaggardsLate MajorityEarly Majority Non-adopters Early Adopters Innovators EMR adopters Type of EMR Users Viewers System Changers Basic UsersStrivers Arrivers

23. SHIRE Achieving Acceptance of Clinical IT Innovators: restraint may be required Early adopters: education on benefits Early majority: education & motivation Late majority: add peer pressure & identification of barriers Laggards: remove barriers, train & support