Using the Electronic Health Record Data in Real Time and Predictive Analytics to Prevent Hospital-Acquired Postoperative/Surgical Site Infections.

Of critical concern to hospitals today is the prevention of postoperative (surgical site) infections that often result in increased lengths of stays for patients, increased resource demands and costs, loss of public trust and lawsuits, and needless pain and suffering for patients and their families. While all surgical patients have the potential to develop a postoperative infection, the main challenge is to identify key risk factors (both patient centered and operational) through an electronic early-warning system to reduce the likelihood of a postoperative infection from occurring. Currently, most postoperative infection risk prevention practices encompass limited use of informatics technologies or do not maximize the potential benefits. In addition, from a research perspective, there has been more focus on extrapolating electronically housed data (eg, from progress notes, operative notes, laboratory, pharmacy, radiology) retrospectively to describe poor patient outcomes for benchmarking purposes (revealing poor results and opportunities for improvement) rather than using similar sources of real-time data to prevent poor patient outcomes from occurring. This article proposes that standardized indicators, both patient centered and operational, linked to the patient's electronic health record could allow for implementation of 24/7, "real-time" monitoring/surveillance to implement well-timed preventive interventions scaled to each patient and facility to assist caregivers in reducing the numbers of postoperative infections and improve the overall quality and costs of patient care.

Developing a hospital-specific electronic inpatient fall surveillance program: phase 1.

Patient falls in hospitals continue to exist as a serious societal problem. The purpose of this study was to analyze nurses' perceptions of patient fall risk factors that may be used to develop an electronic patient decision support system to prevent patient falls. A survey was distributed to 150 nurses in a moderate-size hospital system in Central Florida (200+ beds). Survey questions were developed to identify 3 fall risk factor categories: patient-centered, operational, and critical. Sixty-five surveys (43.3%) were returned. Descriptive statistics such as frequencies and percentages were calculated on all study variables. All participants indicated they were familiar with the circumstances that have contributed to falls or near-falls of patients. Findings included the majority of nurses perceived both patient-centered and operational factors increased the risks for patient falls, with pertinent results indicating a lack of appropriate ambulatory device (90.8%), low to very low nurse staffing levels (87.7%), and a history of a fall within the past year (73.8%) increased the risk for falls. The nurses' perceptions define a standard medical terminology that can be recorded in electronic progress notes and programmed to quickly link to additional sources of fall risk data (eg, laboratory work, medications) housed within the hospital's electronic health record. Further research is needed to assess the feasibility of an electronic health record-based system to prevent hospital falls using risk factors identified in this and other studies.

Electronic fall surveillance system model.

Of primary concern to health care facilities today is the reduction of preventable injuries such as patient falls that often lead to serious and fatal injuries and result in increased lengths of stays, resource demands, costs, and lawsuits. Although all patients have the capacity to fall, a major challenge is to identify the presence of key risk factors exhibited by a patient as soon as possible to reduce the likelihood of an adverse fall event. Currently, fall risk assessment and prevention practices focus on nurses identifying the risk factors for falls with a limited use of technology. This article introduces a preliminary falls risk assessment and prevention model that uses standardized clinical and operational performance indicators linked through the Web to the patient's electronic health record to produce an electronic Fall Surveillance System. The use of an integrated Fall Surveillance System linked directly to the electronic health record allows for the implementation of quick "real-time" preventive intervention that would dramatically improve the quality and costs of patient care.

Coding, reimbursement, and managed care.

This article will discuss the vital link, emerging role, and high financial impact of medical coding to health care reimbursement and managed care. Medical (clinical) coding represents the data requirements needed to support the following:

U.S. health care policy and the rising uninsured: an alternative solution.

The lack of adequate health insurance affects one's ability to access care, which directly affects one's health. In the 21st century, there are 44 million people in the United States without health care insurance. The majority of people without health care insurance are working people under age 65, because most people over age 65 are retired and have health insurance through the federal Medicare program. Maintaining a healthy population makes good business sense because healthy people are more able to work, buy goods, and pay taxes that contribute to a healthy economy and strong government. We must understand, through provider "cost shifting," the American public is already "footing the bill" for the uninsured. However, the actual amount is hidden and passed on to consumers in payments to insurance companies through raised premiums, deductibles, co-payments, exclusions from coverage, and direct out-of-pocket payments to providers (e.g., physicians, hospitals). Ironically, the very working poor who are uninsured and underinsured help fund the health insurance of select federally protected groups through taxation. A huge gap exists in the current United States system of health care wherein there is no cogent benefit, only a vicious cycle as the insured continue to pay more for their care to help compensate provider losses due to the uninsured. This in turn causes a growing rank of uninsured individuals that lack access to adequate health care. The purpose of this article is to assert an alternative to the current U.S. health care insurance system. It takes advantage of structures already in place to promote a "win-win" American health system premised on a workable tiered universal health care system in which there is a benefit to the major populace. As an emanation of a diverse society, the proposed system does not advocate a one-payer universal system that is not amenable to the U.S. health care, social, or political environment.