The movement towards a heightened focus on quality, outcomes and cost requires that healthcare organizations make the best use of data that is available to them. Advancement of health IT in the form EHRs has been an important first step in the health IT movement to accurately capture and house patient data. The next step is to extract important patient information in real-time such that it can be used to impact care delivery in a positive way.
A rich storehouse of data currently exists across the care continuum, but historically, lack of functionality and interconnectivity between disparate systems has made it difficult for this data to be leveraged in a meaningful way for more effective care delivery. For example, while electronic health records (EHRs) facilitate the accurate capture and storage of high volumes of patient data, most hospitals are challenged with how to extract and convert it, in real-time, into actionable information for better decision making.
By Nina West, Pharm.D.
The movement towards a heightened focus on quality, outcomes and cost requires that healthcare organizations make the best use of data that is available to them. Advancement of health IT in the form EHRs has been an important first step in the health IT movement to accurately capture and house patient data. The next step is to extract important patient information in real-time such that it can be used to impact care delivery in a positive way.
A rich storehouse of data currently exists across the care continuum, but historically, lack of functionality and interconnectivity between disparate systems has made it difficult for this data to be leveraged in a meaningful way for more effective care delivery. For example, while electronic health records (EHRs) facilitate the accurate capture and storage of high volumes of patient data, most hospitals are challenged with how to extract and convert it, in real-time, into actionable information for better decision making.
Especially when considering effective population health management (PHM) strategies, the ability to aggregate and view data in meaningful formats is critical to effective responses that maximize safety and minimizes the need for higher-cost interventions. While simplistic in theory, achieving success with PHM requires an advanced technological infrastructure where big data can be leveraged in real-time to support delivery of the best clinical decision support (CDS) at the point of care. Technological advancements in the way of advanced clinical surveillance systems are opening new doors to fully leveraging existing data to positively impact outcomes.
In particular, the use of surveillance technology alongside proper governance strategies proved successful in taking PHM to the next level, as demonstrated by the effective response one Midwest community hospital had to an unexpected outbreak of fungal meningitis in 2012.
The Need for Rapid Response
In October 2012, the Centers for Disease Control and Prevention (CDC) reported an outbreak of fungal contamination traced to three lots of medications packaged at the New England Compounding Center for epidural steroid injections. Prior to identification of the contamination, the medications had been distributed to 75 medical facilities in 23 states and administered to some 14,000 patients. The end result was a fungal meningitis outbreak that impacted more than 700 people across the nation and killed 53.
Following the outbreak, the 500-plus bed community hospital had admitted several patients in October and November who were being treated for meningitis. That number rapidly changed overnight once the CDC announcement was made, as those potentially exposed to the contaminated drugs began flooding local emergency departments (EDs).
Following nearly 20 admissions of patients with fungal meningitis over a two-day period, disaster response measures were initiated. Clinical pharmacy staff had to quickly develop a monitoring program to optimize care delivery and safety for patients.
At the peak of the outbreak, the hospital was managing approximately 80 patients at one time. Time was the essence for effective monitoring, and staff resources were taxed. Without the availability of an advanced surveillance and decision support infrastructure, the hospital would be forced to rely on manual processes for monitoring that could quickly become outdated as new patients were admitted.
Real-Time Monitoring for Long-Term Success
Availability of the Sentri7 electronic surveillance system made it possible for clinical staff to quickly prioritize patients, ensuring that nothing got overlooked, such as changes in organ function and development of electrolyte abnormalities. Staff were able to quickly leverage the system’s rules-based engine to aggregate data from various hospital systems and then monitor that information, delivering critical patient data in real-time.
Leveraging data within the hospital’s EHR, rules were created to identify all patients receiving the antifungal medications. Specifically, anyone with an active order for one of the antifungal medications was immediately placed under monitoring by the surveillance system. Clinical staff used the "INT" form to document details about the patient case. Information was available to clinical staff in real-time as opposed to the extended time it would have taken to sift through printed reports—a critical component to success as data could easily become outdated within minutes as scores of patients were evaluated in the ED.
After the immediate crisis has settled, the electronic surveillance system was used to manage more complicated care issues associated management of the outbreak. Specifically, rules were created to prioritize patients exhibiting symptoms that could require dose adjustments for renal and liver dysfunction or possible drug interactions.
Also critical to the initial crisis and ongoing management was effective communication. Governance processes were put into place that ensured appropriate documentation was entered into the electronic surveillance system to make the transition from shift to shift more efficient and accurate.
Teamwork alongside an advanced technological infrastructure ensured a highly effective response to the fungal meningitis outbreak.
Real-time monitoring ensured the availability of an active, accurate patient list at all times. The pharmacy department as a whole was able to deliver the increased workload needed while maintaining patient safety as a focal point.
Nina West, Pharm.D., is the Clinical Pharmacy Manager and Residency Program Director at a community teaching hospital in the Midwest.
