Investigating multiple sources of data for smart infusion pump and electronic health record interoperability

2020 ◽  
Vol 77 (17) ◽  
pp. 1417-1423
Author(s):  
Kathryn K Marwitz ◽  
Andrew C Fritschle ◽  
Vivek Trivedi ◽  
Matthew L Covert ◽  
Todd A Walroth ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Infusion Pump ◽  
Health Record ◽  
Collaborative Partnerships ◽  
Multiple Sources ◽  
Data Repositories ◽  
Usable Information ◽  
Healthcare Engineering ◽  
Electronic Health ◽  
Smart Pump

Abstract Purpose Infusion pump data, which describe compliance to dose-error reduction software among other metrics, are retrievable from infusion pump vendor software, electronic health record (EHR) systems, and regional and national data repositories such as the Regenstrief National Center for Medical Device Informatics (REMEDI). Smart infusion pump and EHR interoperability has added to the granularity and complexity of data collected, and clinicians are challenged with efficiently comprehending and interpreting the data and reports available. Summary Collaborative partnerships between the Indianapolis Coalition for Patient Safety and the Regenstrief Center for Healthcare Engineering allowed for clinicians, informaticists, researchers, and engineers to compare the information gained and strengths of using smart infusion pumps, EHR, and REMEDI to assess hospital medication safety in a setting of interoperability. Seven reporting capabilities were used to compare available reports, and 2 hypothetical scenarios were developed to highlight these processes. Infusion pump vendor–provided software and reports were found to provide the most usable information for detailed infusion reporting, while the EHR was strongly usable for interoperability compliance and REMEDI excelled in benchmarking capabilities. Conclusion While infusion analytics needs may differ across health systems, a better understanding of the strengths of infusion pump data and EHR data may help provide structure and direction in the infusion analytics process. Infusion data repositories such as REMEDI are useful tools to obtain information in a way not delivered by smart pump data.

scholarly journals The Impact of Disruption of the Care Delivery System by Commercial Laboratory Testing in a Children's Health Care System

2018 ◽  
Vol 143 (1) ◽  
pp. 115-121 ◽  
Author(s):  
Beverly B. Rogers ◽  
James L. Adams ◽  
Alexis B. Carter ◽  
Francine Uwindatwa ◽  
Cynthia B. Brawley ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Median Time ◽  
Laboratory Testing ◽  
Care Delivery ◽  
Reference Laboratory ◽  
Health Record ◽  
Multiple Sources ◽  
Electronic Health Record Data ◽  
Electronic Health ◽  
The Impact

Context.— Disruption of outpatient laboratory services by routing the samples to commercial reference laboratories may seem like a cost-saving measure by the payers, but results in hidden costs in quality and resources to support this paradigm. Objective.— To identify differences when outpatient tests are performed at the Children's Healthcare of Atlanta (Children's) Hospital lab compared to a commercial reference lab, and the financial costs to support the reference laboratory testing. Design.— Outpatient testing was sent to 3 different laboratories specified by the payer. Orders were placed in the Children's electronic health record, blood samples were drawn by the Children's phlebotomists, samples were sent to the testing laboratory, and results appeared in the electronic health record. Data comparing the time to result, cancelled samples, and cost to sustain the system of ordering and reporting were drawn from multiple sources, both electronic and manual. Results.— The median time from phlebotomy to result was 0.7 hours for testing at the Children's lab and 20.72 hours for the commercial lab. The median time from result posting to caregiver acknowledgment was 5.4 hours for the Children's lab and 18 hours for the commercial lab. The commercial lab cancelled 2.7% of the tests; the Children's lab cancelled 0.8%. The financial cost to support online ordering and reporting for testing performed at commercial labs was approximately $640,000 per year. Conclusions.— Tangible monetary costs, plus intangible costs related to delayed results, occur when the laboratory testing system is disrupted.

Impact of smart pump-electronic health record interoperability on patient safety and finances at a community hospital

2021 ◽  
Author(s):  
Wenfei Wei ◽  
William Coffey ◽  
Mobolaji Adeola ◽  
Ghalib Abbasi
Keyword(s):  
Patient Safety ◽  
Electronic Health Record ◽  
Community Hospital ◽  
Financial Impact ◽  
Health Record ◽  
Current Procedural Terminology ◽  
Smart Pumps ◽  
Final Article ◽  
Electronic Health ◽  
Smart Pump

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose Integrating smart pumps with an electronic health record (EHR) reduces medication errors by automating pump programming and EHR documentation. This study describes the patient safety and financial impact of pump-EHR interoperability at a community hospital. Methods A 316-bed community hospital in Sugar Land, TX, went live with pump-EHR interoperability in October 2019. Data were collected from April 1, 2019, to June 30, 2019 (before implementation) and from April 1, 2020, to June 30, 2020 (after implementation). Rates of drug library compliance, alert firing, alert override, override within 2 seconds, high-risk alert override, and alert resulting in pump reprogramming were measured. Financial impact was measured by Current Procedural Terminology code capture per kept appointment in the infusion center. Results Drug library compliance increased from 73.8% to 82.9% with pump-EHR interoperability (P < 0.001). Infusions generating alerts among all infusions programmed with the drug library decreased from 3.5% to 2.6% (P < 0.001), overridden alerts increased from 64.8% to 68.9% (P < 0.001), alerts overridden within 2 seconds decreased from 17.3% to 13.8% (P < 0.001), and reprogrammed alerts decreased from 20.7% to 18.3% (P = 0.002). Conclusion Pump-EHR interoperability leads to safer administration of intravenous medications based on improved drug library compliance and more accurate smart pump programming.

scholarly journals A methodology to generate longitudinally updated ACLF prognostication scores from electronic health record data

2020 ◽  
Author(s):  
Jin Ge ◽  
Nader Najafi ◽  
Wendi Zhao ◽  
Ma Somsouk ◽  
Margaret Fang ◽  
...  
Keyword(s):  
Electronic Health Record ◽  
Chart Review ◽  
Health Record ◽  
Electronic Health Record Data ◽  
Cohen’S Kappa ◽  
Data Repositories ◽  
Patient Admissions ◽  
Cohen's Kappa ◽  
Electronic Health ◽  
End Stage

AbstractBackground and AimsQueries of electronic health record (EHR) data repositories allow for automated data collection. These techniques have not been utilized in hepatology due to previous inability to capture hepatic encephalopathy (HE) grades, which are inputs for acute-on-chronic liver failure (ACLF) models. Here, we describe a methodology to utilizing EHR data to calculate rolling ACLF scores.MethodsWe examined 239 patient-admissions with end-stage liver disease 7/2014-6/2019. We mapped EHR flowsheet data to determine HE grades and calculated two longitudinally updated ACLF scores. We validated HE grades and ACLF diagnoses via chart review; and calculated sensitivity, specificity, and Cohen’s kappa.ResultsOf 239 patient-admissions analyzed, 37% women, 46% non-Hispanic White, median age 60 years, median MELD-Na at admission. Of the 239, 7% were diagnosed with NACSELD-ACLF at admission, 27% during the hospitalization, and 9% at discharge. Forty percent diagnosed with CLIF-C-ACLF at admission, 51% during the hospitalization, and 34% at discharge.From chart review of 51 admissions, we found sensitivities and specificities for any HE (grades 1-4) were 92-97% and 76-95%, respectively; for severe HE (grades 3-4) were 100% and 78-98%, respectively. Cohen’s kappa between flowsheet and chart review HE grades ranged 0.55-0.72. Sensitivities and specificities for NACSELD-ACLF diagnoses were 75-100% and 96-100%, respectively; for CLIF-C-ACLF diagnoses were 91-100% and 96-100%, respectively. We generated approximately 28 unique ACLF scores per patient per admission-day.ConclusionIn this study, we developed an informatics-based methodology for to calculate longitudinally updated ACLF scores. This opens new analytic potentials, such big data methods to develop electronic phenotypes for ACLF patients.

scholarly journals Electronic health record and blockchain architecture: forensic chain hypothesis for human identification

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
E. Nuzzolese
Keyword(s):  
Electronic Health Record ◽  
Human Identification ◽  
Electronic Record ◽  
Forensic Odontology ◽  
Health Record ◽  
Record System ◽  
Data Repositories ◽  
Dental Identification ◽  
Blockchain Technology ◽  
Electronic Health

Abstract Background Forensic dental identification relies on the collection and comparison of antemortem and postmortem dental data and dental evidence. There are software solutions capable of archiving postmortem (PM) and antemortem (AM) data, with search and comparative tools which are user-centric and do not allow open search options and data mining of all dental related data, except through the use of coded data. This reduces interoperability and raises dental data incompatibility challenges. Blockchain technology could help introduce a trusted, secure, and holistic ecosystem in the electronic health record (EHR) system with a forensic interface accessed by experts in forensic pathology and forensic odontology for the purpose of identifying human remains and retrieve identifying data of compatible missing persons from the health and dental electronic record system, with the further advantage of protecting data breaches, redundancies, inconsistencies, and errors. Blockchain technology, and a forensic chain, can enhance forensic data management and human identification process by managing the missing person lists, create AM data repositories as shared data with the EHRs of living individuals, create PM data repositories of recovered from identifying autopsies unidentified persons, and support the preliminary comparison of compatible biological profiles during the final reconciliation phase. Conclusion In this hypothesis, author investigates possible applications of blockchain technology as a holistic technical and interoperability solution for managing both health/dental data for a medical as forensic human identification use.

scholarly journals Design of a Medication Reconciliation Application

2013 ◽  
Vol 04 (01) ◽  
pp. 110-125 ◽  
Author(s):  
K. Spry ◽  
J. Morea ◽  
A. L. Russ ◽  
J. Duke ◽  
M. Weiner ◽  
...  
Keyword(s):  
Decision Making ◽  
User Interface ◽  
Electronic Health Record ◽  
Medication Reconciliation ◽  
Clinical Decision Making ◽  
Data Sources ◽  
Health Record ◽  
Multiple Sources ◽  
Medication Information ◽  
Electronic Health

SummaryBackground: Medication reconciliation is an essential, but resource-intensive process without a “gold standard” to measure medication adherence. Medication reconciliation applications that focus on facilitating clinicians’ decision-making are needed. Since no single available source of medication information is adequate, combining data sources may improve usefulness and outcomes.Objectives: We aimed to design a medication reconciliation application that could incorporate multiple data sources and convey information about patients’ adherence to prescribed medications. We discuss design decisions integral to developing medication reconciliation applications for the electronic health record. The discussion is relevant for health IT developers, clinical providers, administrators, policy makers, and patients. Three hypotheses drove our design of this application: 1) Medication information comes from a variety of sources, each having benefits and limitations; 2) improvements in patient safety can result from reducing the cognitive burden and time required to identify medication changes; 3) a well-designed user interface can facilitate clinicians’ understanding and clinical decision making.Methods: Relying on evidence about interface design and medication reconciliation, an application for the electronic health record at an academic medical center in the U.S. was designed. Multiple decisions that considered the availability, value, and display of the medication data are explored: Information from different sources; interval changes in medications; the sorting of information; and the user interface.Results: The prototype medication reconciliation application design reflects the visual organization, categorization, modality of interactions, and presentation of medication information from three data sources: patient, electronic health record, and pharmacy.Conclusions: A new medication reconciliation user interface displays information from multiple sources, indicates discrepancies among sources, displays information about adherence, and sorts the medication list in a useful display for clinical decision making. Gathering, verifying, and updating medication data are resource-intensive processes. The outcomes of integrating, interpreting, and presenting medication information from multiple sources remain to be studied.Citation: Cadwallader J, Spry K, Morea J, Russ AL, Duke J, WeineM. Design of a medication reconciliation application – facilitating clinician-focused decision making with data from multiple sources. Appl Clin Inf 2013; 4: 110–125http://dx.doi.org/10.4338/ACI-2012-12-RA-0057

Business: The Electronic Health Record: Front Line Experience

2011 ◽  
Vol 21 (1) ◽  
pp. 18-22
Author(s):  
Rosemary Griffin
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Electronic Health Record ◽  
Financial Incentives ◽  
Best Practice ◽  
Health Care Systems ◽  
The United States ◽  
Health Record ◽  
Health Trends ◽  
Electronic Health

National legislation is in place to facilitate reform of the United States health care industry. The Health Care Information Technology and Clinical Health Act (HITECH) offers financial incentives to hospitals, physicians, and individual providers to establish an electronic health record that ultimately will link with the health information technology of other health care systems and providers. The information collected will facilitate patient safety, promote best practice, and track health trends such as smoking and childhood obesity.

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