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
Project
Technology Assisted Academic Detailing (Bailey) Cholesterol Education And Research Trial (Eaton)
Project description
Automated ID of inpatient candidates for primary and secondary CHD prevention to facilitate academic detailing
Waiting room patient activation software combined with PDA-based decision support for cholesterol management
Guideline PDA-based decision support and Adherence for academic detailing for cholesterol Heart Health (Goff) management
Transfusion CDS CPOE-based decision support for (Rothschild) inpatient transfusions
TAAD, CEART, GLAD, T-CDS
CEART
Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1:2-4.
Technology Assisted Academic Detailing (TAAD) Bailey et al
Automated identification of inpatient candidates for CHD prevention medications, coupled with pharmacistmediated 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 reviews alerts and evaluates for intervention
Pharmacist approaches physicians with 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
Cholesterol Education and Research Trial (CEART) Eaton, et al
Pt activation tool
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
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