Integrating Healthcare Information Technology (HIT) into

Clinical Practice

David K. Ahern, PhD, Thomas C. Bailey, MD, Charles B. Eaton MD, MS, David C. Goff, Jr, MD, PhD,

Jeffrey Rothschild, MD

For the Innovative Strategies Writing Group

Objectives

Illustrate approaches using information technology to improve adherence to guidelines

Identify selected barriers and facilitators for these approaches

List some of the preliminary lessons learned

Study Approaches Using HIT

CPOE-based decision support for inpatient transfusions

Transfusion CDS (Rothschild)

PDA-based decision support and academic detailing for cholesterol management

Guideline Adherence for Heart Health (Goff)

Waiting room patient activation software combined with PDA-based decision support for cholesterol management

CholesterolEducation AndResearchTrial (Eaton)

Automated ID of inpatient candidates for primary and secondary CHD prevention to facilitate academic detailing

TechnologyAssistedAcademicDetailing (Bailey)

Project descriptionProject

Wagner EH. Chronic disease management: what will it take to improve care for chronic illness? Eff Clin Pract. 1998;1:2-4.

TAAD, CEART, GLAD, T-CDS

CEART

Technology Assisted Academic Detailing (TAAD) Bailey et al

Automated identification of inpatient candidates for CHD prevention medications, coupled with pharmacist-mediated academic detailing to improve adherence to:

CHD secondary prevention guidelines for patients with AMI Cholesterol lowering guidelines for patients with diabetes

Patient identification using automated screening CHD/AMI – troponin-based screening DM – algorithm based on prior ICD-9, glucose, HA1c,

medications

Alert generated from patient data

Pharmacist approaches physicians with intervention

Pharmacist reviews alerts and evaluates for intervention

Barriers to TAAD Workflow issues

Timing of alert generation, response Short lengths of stay

Screening/alert to intervention time must be efficient

Personnel issues Prospective intervention requires personnel to

handle alerts

Facilitators of TAAD

IT infrastructure Flexibility to adapt to workflow Efficient methods of candidate identification Dedicated pharmacist resources Pre-existing pharmacist and physician culture High profile issues of recognized importance Both external and internal pressures to succeed

Lessons Learned from TAAD

Technical efficiencies make the impossible possible

Resource and workflow constraints are critical considerations

In asynchronous mode of decision support, must make sure physicians follow through

A pharmacist champion coupled with regular performance feedback is key

Pt activation tool

Cholesterol Education and Research Trial(CEART) Eaton, et al

PDA Decision Support Tool with Patient

Education Screen

Barriers to CEART & GLAD

Some patients were not technology oriented and wouldn’t use computer kiosk (CEART)

Varying physician experience with PDAs and technology for decision support

Physician workflow (and apparel) issues

Facilitators to CEART & GLAD

Design and development of tools based upon qualitative and formative research with patients and physicians

Training and reinforcement in use of tools Academic detailing regarding guidelines Inclusion of other software (e.g, ePocrates) Mobility and efficiency of PDA as a platform for

decision support tool Appeal and ease-of-use of patient activation tool

(CEART)

Lessons Learned from CEART & GLAD

Both patients and physicians need training and reinforcement in use of technology

Both technical and organizational challenges need to be addressed

Clinical decision support enabled by HIT requires integration with workflow

Questions

?