© VANDERBILT UNIVERSITY 2008

Inpatient Clinical

Information Systems,

Decision Support,

and Analysis

Russ Waitman, PhD

Collaborators:

Asli Ozdas, PhD

Josh Peterson, MD, MPH

Jack Starmer, MD

Randolph Miller, MD

Department of Biomedical

Informatics

Vanderbilt University Medical

Center

OBJECTIVE:

Develop content driven Clinical

Information Systems that provide

rich decision support. Use clinical

information systems as a vehicle

for improving patient care in the

context of larger health care

process changes. Harvest and

analyze the resulting data to better

understand healthcare delivery,

disease processes, and optimize

therapy.

INTRODUCTIONVanderbilt University Medical Center has

accumulated a critical mass of inpatient clinical

information systems that can be used to influence

health care delivery and resulting data may

inform us about clinical processes. The

WizOrder/Horizon Clinicals team and its

collaborators design, operate, and analyze such

systems.

CURRENT SYSTEMS/RESOURCES

OTHER RESOURCES/SYSTEMSContent Management tools and databases

(orderables, ordersets, drug decision

support, advisors); Barcoded medication

administration (BCMA), AdminRx; Data mart

of order transactions, user keystroke logs,

lab results; CareOrganizer/STAT interfaces

PROJECTS1. Leverage improvements in microbiology

systems to enhance antimicrobial stewardship

2. Quantify the hospital’s medication

administration performance with BCMA data

3. Enhance medication reconciliation with

codification via RxNorm

4. Streamline discharge and transfer processes

5. Conduct knowledge discovery on inpatient

data linked to mortality by incorporating Social

Security Death Index data. Investigate newer

database technologies for clinical data mart.

6. Evaluate the impact of inpatient/outpatient

allergy integration

7. Enhance Alerting/Task list tools for nursing.

8. Continuous protocol evaluation: are nurse

managed heparin and insulin optimizing care?

9. Build systems to monitor drug decision

support effectiveness; build new approaches

that suggest personalized alternatives.

10. New sources for decision support: create a

Vital Signs Repository with q30second data and

integrate with perioperative systems

WizOrder/Horizon Expert

Orders

Horizon Expert Documentation

Adverse Drug Event

Surveillance

Medication Reconciliation

Medication Management Process Surveillance

Formulary, purchasing decisions

Inventory management

Dispense/distribute

medication

Obtain Medication-

related History

Document Medication

History

Diagnostic/ Therapeutic Decisions

Made

Medication Ordered

Evaluate orderSelect

medication

Educate patient

regardingmedication

Order verified and submitted

Prepare medication

Educate staff regarding

medications

History-Taking

Ordering

Pharmacy Management

Education

Select thecorrect drug for

the correctpatient

Administeraccording toorder and

standards fordrug

Documentadministrationand associated

information

Assess and document

patient response

to medicationaccording to

defined parameters

Intervene asindicated for

adversereaction/error

Administer MedicationMonitor/Evaluate Response Document

Medication Inventory Management

Administration Management

Monitoring and Surveillance

Surveillance

FCG, VHA Inc. after Bates et al. JAMA 1995

Kilbridge 2005

CPOE

HMM Pharmacy System

Bar code admin; eMAR; smart IV pumps, Discharge Med Reconcilation

Surveillance monitors all stages in Medication Management Process

Pre-admit Medication list

ConnectRx Carosel