IT Update: Leveraging Information From Electronic Health Records to Improve Patient Care
As St. Louis Children’s Hospital (SLCH) works to implement an ever-growing number of clinical information systems documenting care delivery, opportunities also expand for using that data to improve quality and processes, promote practice-based learning, and advance research. This science of leveraging clinical patient information is called health informatics, and its implementation at SLCH is a major focus of new committees established by Feliciano Yu, Jr., MD, the hospital’s chief medical information officer and medical director of the Washington University Pediatric Computing Facility.
“St. Louis Children’s Hospital is among the early adopters of health information technology at the national level,” says Dr. Yu. “In order for us to take this technology to the next level—leveraging the collected data to improve patient care—we need in place the technology infrastructure, effective processes and, most importantly, multidisciplinary groups of people devoted to moving SLCH’s health informatics efforts forward.”
Dr. Yu and Christine Pavlak, RPh, SLCH director of pharmacy, labs and material services, co-chair the Medical Informatics Committee. The committee governs the informatics push for the organization, defining the technical, functional and information requirements for the hospital’s clinical information systems. Working in conjunction with the committee is the Project Management Office (PMO), which is responsible for implementing the requirements identified.
“We envision this as you would construct a house. The Medical Informatics Committee serves as the architects, designing our systems’ infrastructures. The PMO is the construction company that builds and implements the systems. And the people living in that house—the systems’ end users—serve as design and build consultants,” says Dr. Yu. “A new piece of this design/build scenario is that now we must incorporate methods on how we can retrieve data when we need it, rather than just concentrating on how to input information.”
As part of the Medical Informatics Committee, Dr. Yu has established three subcommittees to focus on various aspects important to developing effective health informatics systems. The subcommittees are co-chaired by physicians chosen for their leadership qualities and experience with and interest in health informatics.
“These subcommittees are key because they serve as the work groups, the engine, for moving our efforts forward,” says Dr. Yu.
Electronic Health Records Subcommittee
Co-chairs: Stuart Sweet, MD, PhD, pediatric pulmonologist and medical director, lung transplant program at SLCH
Jane Zbinden, SLCH director of health information management (HIM)
This new subcommittee works in cooperation with the HIM committee of the medical staff, which Dr. Sweet also chairs.
“Piggybacking the work of these two committees provides an administrative structure that promotes shared responsibility and authority between the hospital and physicians,” explains Dr. Sweet. “Essentially, we are responsible for making sure the information that goes into what is an evolving concept of an electronic health record meets the needs of clinicians and others who must access information, as well as satisfies legal, insurance and regulatory requirements. Historically, these were based on the existence of a set of paper records, whereas now health records have moved into the electronic arena.”
A challenge faced by the subcommittee is first defining what information stored in many different systems constitutes legal records for patients. A further complication is maintaining accuracy across many systems that contain duplicate information that may or may not be changed over the course of a patient’s treatment.
“It’s like going from a horse and buggy to an automobile in terms of level of complexity,” says Dr. Sweet. “We function as the end-user group that helps the system developers determine the best way for information to be presented electronically and ensures the information meets the rules and regulations of the hospital or regulatory bodies like The Joint Commission.”
Clinical Decision Support Subcommittee
Co-chairs: S. Paul Hmiel, MD, PhD, pediatric nephrologist and medical director, kidney transplant program at SLCH
Melissa Heigham, PharmD, SLCH manager of clinical pharmacy services
This subcommittee is responsible for developing the documents and policies clinicians need to make treatment decisions that positively affect patient outcomes.
“We are developing the support processes that help physicians ensure accuracy when they are ordering medications, treating a specific illness or needing to consult reference materials,” says Dr. Hmiel. “At the most basic level, we are creating the means by which physician groups may develop electronic order sets that provide guidance on treating illnesses such as appendicitis or asthma as well as links to guidelines or research that support the treatment protocols. We also are searching out the reference books and cards physicians and nurses carry in their pockets or post at work stations so that we can have those available in a single place within the KiDDOS system.”
He adds, “We are working with representatives from other pediatric groups within the BJC system, such as those at Progress West, Missouri Baptist Medical Center and Boone Hospital Center, so we can all share the same order support and references electronically.”
For the future, the subcommittee is looking toward developing adverse event detection systems that will, in real time, alert caregivers to potential problems patients may develop based on such factors as diagnosed illness, laboratory test results, vital signs and prescribed medications.
“Being able to predict a potential problem before a patient experiences it will be a significant step toward our ultimate goal of improving patient outcomes and safety,” says Dr. Hmiel.
Clinical Analytics Subcommittee
Co-chairs: Kimberly Quayle, MD, pediatric emergency medicine physician and clinical director, Emergency Department at SLCH
Mark St. Aubin, director, SLCH quality management
This subcommittee’s goal is to centralize access to data sources at SLCH, BJC HealthCare, Washington University and external entities.
“Currently, there is no centralized way for anyone to get data,” says Dr. Quayle. “If people doing research or quality improvement need information, many times they need to make educated guesses as to whom to call for data. Sometimes they find it, sometimes they don’t.”
The subcommittee’s first task was creating an inventory of the data sources available throughout Children’s Hospital, BJC and Washington University. More than 90 different information systems were identified. Now the subcommittee is working to streamline the process of accessing data.
“We are proposing to develop a Web-based data request system by which people can fill out a simple form giving us details about the information being requested, why it is needed, and any deadline constraints,” says Dr. Quayle. “As requests come in, they will be reviewed by members of the subcommittee, and an appropriate data source will be identified. In most cases, we believe we’ll be able to identify an ideal source of information for each request.”
The computerized requests also will help keep a record of information gathered, which will help eliminate duplicated work when similar data requests are made.
