Impact of health information technology on detection of potential adverse drug events at the ordering stage.

PURPOSE: The impact of implementing commercially available health care information technologies at hospitals in a large health system on the identification of potential adverse drug events (ADEs) at the medication ordering stage was studied. METHODS: All hospitals in the health system had implemented a clinical decision-support system (CDSS) consisting of a centralized clinical data repository, interfaces for reports, a results reviewer, and a package of ADE alert rules. Additional technology including computerized provider order entry (CPOE), an advanced CDSS, and evidence-based order sets was implemented in nine hospitals. ADE alerts at these hospitals were compared with alerts at nine hospitals without the advanced technology. A linear mixed-effects model was used in determining the mean response profile of six dependent variables over 28 total months for each experimental group. RESULTS: Overall, hospitals with CPOE and an advanced CDSS captured significantly more ADE alerts for pharmacist review; an average of 336 additional potential ADEs per month per hospital were reviewed. Pharmacists identified some 94% of the alerts as false positives. Alerts identified as potentially true positives were reviewed with physicians, and order changes were recommended. The number of true-positive alerts per 1000 admissions increased. CONCLUSION: The implementation of CPOE and advanced CDSS tools significantly increased the number of potential ADE alerts for pharmacist review and the number of true-positive ADE alerts identified per 1000 admissions.

Transformation of Emergency Department processes of care with EHR, CPOE, and ER event tracking systems.

Mercy Medical Center, North Iowa implemented electronic health records (EHR), computerised provider order entry (CPOE) and event tracking systems in the emergency department (ED) as part of hospital-wide implementation of clinical information systems. This case study examines the changes in outcomes and processes in the ED following implementation. Although the system was designed to enhance efficiency, there was a significant increase in the mean length of stay (about 17 minutes, or 15%) in the ED after implementation. This surprising finding was examined in relationship to the multiple process-of-care changes in the ED.

Redesigning care delivery through health IT implementation. Exploring Trinity Health's IT model.

Trinity Health is a large multihospital healthcare system that developed a system-wide information technology strategy and implementation model. This study looks at how that system-wide strategy and implementation model, called Project Genesis, was used at Mercy Medical Center-North Iowa, a Trinity Health rural referral hospital, and how the care delivery system was redesigned using an electronic health record. This study was funded in part by a grant (UC1 HS15196; Rural Iowa Redesign of Care Delivery with EHR Functions) from the Agency for Healthcare Research and Quality to implement an integrated EHR system in the hospital and two clinics and assess its impact on patient safety, quality of care and organizational culture. The study looks at redesigning care delivery using the Trinity Implementation Model that consists of local and system-wide planning components; physician and nurse ownership; order set development; clinical workflow redesign; and training and support. It then examines the initial experiences of the IT implementation at Mercy Medical Center-North Iowa, the impact on health information management, lessons learned and future steps to achieve a paperless medical record.