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The power of real-time clinical intelligence in infection and disease control

Adam Klass
Adam Klass, Chief Technology Officer, VigiLanz

The statistics are staggering: Every hour, every day, 136 people in hospitals are affected by sepsis, 82 contract a Healthcare Acquired Infection (HAI) and 217 experience a preventable Adverse Drug Event (ADE). Imagine the impact on patient outcomes and population health if clinicians knew – right away – when a patient had sepsis, CDiff, MRSA or Ebola. Or if they knew in real-time when a patient suffered from an adverse event or medication error, or had an elevated risk of DVT or falling.

The exciting news is that a new category of technology, which leading healthcare analysts call “Enterprise Intelligence Resources” (EIR), has the potential to help drive these numbers toward zero by empowering clinicians with actionable insights they can use to more effectively prevent and manage infections, control disease, reduce patient safety risk and optimize quality care.

Built on flexible, interoperable data architectures, EIRs complement existing EMR technology by integrating clinical intelligence, business intelligence, surveillance and predictive analytics. Unlike EMRs, which are rigid documentation and workflow systems, highly adaptable EIR platforms use robust, exception-based, temporal rules, algorithms and events to sort through massive amounts of data from multiple sources. As a result, they can tell frontline clinicians in real-time what is happening – and what is likely to happen – with their patients.

The most effective EIRs engineer these real-time intelligence services to fit effortlessly into clinicians’ workflows. By generating only essential alerts and avoiding alerts for issues clinicians would typically address in their daily work as part of good medical practice, this approach minimizes alert fatigue.

Conquer the sepsis challenge

The identification and treatment of sepsis provides a vivid example of the ability of EIRs to transform real-time and retrospective metadata into opportunities to positively impact patient care – and rein in associated costs – through better informed decision-making.  Sepsis poses a huge risk for patients and a huge challenge for hospitals. It affects more than one million patients annually, causes 280,000 deaths each year and is the number one cause of death in non-coronary ICUs. Treatment for sepsis accounts for 40 percent of ICU spending and nearly $29 billion in overall healthcare costs.

Over the past decade, research has proven that the earlier the intervention in sepsis, the significantly lower the mortality and morbidity. Armed with this knowledge, providers can take advantage of EIR platforms to:

  • Identify at-risk patients earlier. Using scores of potential inputs from historical hospital data, the EIR can create a profile and scoring system to compute a sepsis risk score for each patient, flagging those whose risk exceeds a pre-defined threshold.
  • Methodically and automatically track this sub-population. The patients’ sepsis diagnostics and vital signs are closely monitored and risk scores are updated in the EMR.
  • Alert clinicians to initiate appropriate interventions as needed. Continue to monitor organ function and physiologic response so treatment can be adjusted according to defined protocols.

Implementing this approach can produce dramatic results. For example, we have seen clients reduce sepsis occurrence by as much as 22 percent.

Empower informed decision-making

EIR predictive modeling platforms can analyze data specific to any patient population and clinical issue, making them highly effective in addressing a broad range of challenges relating to infection prevention, chronic disease control and patient safety risk. These include, but are certainly not limited to, HAI, CDiff, MRSA, DVT, toxic hyperkalemia, glycemic control, pressure ulcers, surgery site infections (SSIs), diabetes, chronic heart failure and COPD.  

Automated, continuous surveillance also helps rapidly identify HAI threats and resistance patterns, track hotspot disease trends, control emerging infection risks and prevent further infections. Plus, EIRs expedite reporting to meet state and federal requirements, including National Healthcare Safety Network reporting.

In addition, customized EIR pharmacy surveillance can be used to automatically screen and monitor patients based on a hospital’s own internal guidelines, providing oversight that helps anticipate and prevent ADEs.  EIRs also improve antimicrobial stewardship, helping to control the use of expensive drugs and decrease antibiotic utilization through real-time drug dosing, exception-based tracking and national benchmarking.

Seamlessly integrate with EMRs    

Using the software-as-a-service (SaaS) model, EIRs can be delivered without putting additional burdens on hospital IT departments whose resources are likely stretched thin already. The solutions, which require no special hardware or software, can be implemented rapidly – generally within 90 business days – and seamlessly integrated with existing EMR systems.

Other valuable EIR features to look for include:

  • EIR platforms should interface with any dataset, EMR or other system.
  • Patient dashboards. Centralizing patient-specific data, including charts, notes from multiple clinicians and timeline views, helps expedite patient assessment.
  • Multi-modality. The platform should be accessible via any stationary or mobile device, including tablets, desktops, laptops and smartphones.
  • True real-time capacity. A continuous real-time service, versus batched information or report-centered intelligence, processes EMR and other health data every one to two minutes and delivers alerts tailored to individual patient information.
  • Data should be encrypted and the platform should be managed in highly secure, redundant data centers.
  • Hospitals using proven EIR platforms often see measurable improvements in clinical outcomes and cost savings within 12 months.
  • Continuous learning. A data warehouse that stores metadata collected through continuous clinical surveillance can leverage analytical models to determine causal relationships and drive quality improvement.
  • Expert vendor support. Implementation, configuration, training and ongoing support from an experienced vendor services team helps hospitals optimize EIR performance. The team should also include clinicians who can ensure the technology is consistently meeting clinician needs and effectively supporting patient well-being.

The simple fact is, despite the billions of dollars invested, current EMR technology lacks the ability to deliver real-time, patient-centric care. Therefore, EIRs that aggregate and process data across proprietary, crowd-sourced and evidence-based real-time, smart rules are a necessary complement in today’s value-based healthcare environment. By linking cause and effect in key risk areas, providing real-time intelligence that informs smarter decision-making and instilling improved care protocols directly into the clinical workflow, EIRs support improved infection and disease control that optimizes patient outcomes and saves lives.

ADE, Adverse Drug Event, EIR, Enterprise Intelligence Resources, HAI, Healthcare Acquired Infection, infection and disease control, sepsis, VigiLanz