Page 87 - Hall et al (2015) Principles of Critical Care-McGraw-Hill

CHAPTER 8: Principles of Medical Informatics and Clinical Informatics in the ICU 55

■ FACTORS AFFECTING HIT ADOPTION GLOSSARY OF TERMS

A recent survey of US hospitals showed that hospitals that had adopted Clinical Decision Support Systems (CDSS) or Decision Support System
either basic or comprehensive electronic records have risen modestly, (DSS) or Clinical Decision Support (CDS) Computer-based application
from 8.7% in 2008 to 11.9% in 2009 and increasing at about 3% to 6% provides reminders and best-practice guidance in the context of data spe-
per year. Health care is still behind other industries in the adoption cific to the patient that helps physicians make clinical decisions.
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of information technology. Implementation of HIT faces a number of
barriers, including institutional, cognitive, liability, knowledge, and Computerized physician order entry (CPOE) Computer system that
attitudinal. Before adoption of HIT, health care organizations should allows direct entry of medical orders to EMR.
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consider the following: Critical Care Information System (CCIS) Electronic medical record
implementing specific requirements for care ICU patients.
• Early adopter experience: The experience of early adopters of HIT
has an influence on followers. Data warehouse or Central Data Repository (CDR) Collection of data
• Legacy systems: Unique disparate systems cannot be replaced with gathered from one or more data repositories to create a central database.
Data warehousing also includes the architecture and tools needed to col-
new systems on an ad hoc basis. Many institutions are stuck with old lect, query, analyze, and present information.
systems that cannot integrate with new EHR. Electronic medical record (EMR) or electronic health record (EHR) or
• Inadequate standards: Lack of interconnectivity and interoperability computer-based patient record (CPR) Variations of terms for all electronic
between different vendors can represent a key barrier to adoption patient care systems containing current and historical patient information.
across a health care practice.
• Lack of capital and access to technology: HIT requires a large initial Electronic patient record (EPR) Similar to the EMR, but focuses on
information gathered by specific provider.
investment in technology and human resources. That cost is often
underestimated at the planning phase. Health information technology (HIT) The application of information
processing involving both computer hardware and software that deals
• Operating costs: Ongoing maintenance and operation costs of HIT with the storage, retrieval, sharing, and use of health care information,
are significant. data, and knowledge for communication and decision making.
• Risk-reward perception: Implementation of EHR may introduce Hospital Information System (HIS) or Clinical Information System
a period of lower productivity during learning and adoption of a (CIS) Comprehensive, integrated computerized information system
new system. designed to manage clinical, administrative, and financial aspects of a hospital.
■ NEXT GENERATION OF ICU EHR Infobutton Context-specific link from EMR to other resources that
provides information that might be relevant to the initial context.
Today clinicians are faced with information overload. Raw data are Patient health record (PHR) Managed and controlled by the patient
indiscriminately presented from multiple sources with minimum or no and is mostly Web-based.
integration. The care of critically ill patients generates a median of 1348 Picture Archiving and Communication Systems (PACS) Clinical
individual data points/day and this quantity has increased 26% over computer system for storage, rapid retrieval, and access to images
5 years. Important data elements are distributed across many different acquired with multiple modalities.
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computer platforms and applications. This makes diagnostic pattern Often terms HIT, clinical information technologies (CIT), and EMR
recognition difficult for clinicians and in the context of the critical care systems are used interchangeably.
environment can lead to delays in diagnosis and delivery of care.
A future generation of EHR needs to exploit the advantages offered HELPFUL RESOURCES
by the digitalization of the ICU environment. Key functionalities will
include • Certified HIT Product List (CHPL) provides a comprehensive list-
• Detection of the clinical context in which they are operating ing of complete EHRs and EHR modules that have been tested and
• Reduce information overload by configuring the user interface to certified under the Temporary Certification Program maintained by
the Office of the National Coordinator for Health IT (ONC) (http://
preferentially display subsets of task specific data to bedside provid- onc-chpl.force.com/ehrcert).
ers at the point of care
• Provide decision support • The Office of the National Coordinator for Health Information
Technology (ONC)—http://healthit.hhs.gov.
• Provide systems surveillance of health care delivery and real time • A resource of information that contains literature about the benefits
feedback on performance with reference to established standards of HIT is the Searchable Health Information Technology Costs &
of care Benefits Database from AHRQ (http://healthit.ahrq.gov/tools/rand).
• Be seamlessly integrated into the environment and workflow in a
manner that exploits our understanding of distributed cognitive
function and “choice architecture” to optimize patient-centered KEY REFERENCES
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outcomes • Ali NA, Mekhjian HS, Kuehn PL, et al. Specificity of computerized
• Secondary data use in the development of sophisticated models of physician order entry has a significant effect on the efficiency of
critical illness syndromes, which will form the basis of comparative workflow for critically ill patients. Crit Care Med. 2005;33(1):110-114.
effectiveness research and in silico clinical trials • Amarasingham R, Pronovost PJ, Diener-West M, et al. Measuring
• Support cost-effective administrative decision making through the clinical information technology in the ICU setting: application
automated measurements and analysis of processes of care essential in a quality improvement collaborative. J Am Med Inform Assoc.
to quality improvement initiatives 2007;14(3):288-294.
• Support the identification and recognition of patients with poten- • Angus DC, Kelley MA, Schmitz RJ, White A, Popovich J Jr.
tial or established critical illness outside critical care areas for the Caring for the critically ill patient. Current and projected work-
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purpose of timely intervention and enrollment in clinical research force requirements for care of the critically ill and patients with
trials

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