Electronic Health Records

Adoption & Implementation News

Clinical Decision Support Decreases Sepsis Mortality in AL

As part of an electronic surveillance program, clinical decision support helped reduce sepsis mortality by 53 percent.

By Kyle Murphy, PhD

- A pair of clinical informaticist consultants found clinical decision support (CDS) systems to have a positive impact on identifying instances of sepsis and reducing sepsis mortality at an Alabama hospital.

Clinical decision support and sepsis mortality

According to the research published in the Journal of the American Medical Informatics Association, the combination of a computerized surveillance algorithm and CDS tools amounted to 53 percent fewer deaths per 1000 cases (i.e., 40 deaths) as compared to the control group with 90 deaths per 1000 cases. When identifying sepsis identification more widely using IDC-9 codes, the former figure dropped to a still significant 41 percent lower mortality.

"We believe that the highly accurate alerts (sensitive and specific) in the system designed for this study minimized alert fatigue, allowing optimal clinician utilization of the system, and, when combined with the timely detection of sepsis allowed by the system, resulted in the positive outcome of significantly reduced sepsis mortality in the study population," concluded Sharad Manaktala and Stephen Claypool of Wolters Kluwer Health.

The real-time electronic surveillance of sepsis went live in two units of Huntsville Hopsital back in 2014. As the authors described, the system includes four different types of alert notifications for clinical staff.

  • CONNECT Bill Boosts Prospects for Telehealth Integration
  • Will EHR Optimization Projects Take Center Stage in 2016?
  • Debate over pros, cons of Epic EHR adoption continues
  • Should VT open a brand new hospital without an EHR?
  • Health IT Standards, Interoperability to Gain Traction in 2017
  • EHR Adoption Gaps Remain Key Barriers in Annual ONC Report
  • Tips for Reversing Physician Burnout Caused by EHR Use
  • AHA Backs Thune Legislation to Meaningful Use Requirements
  • What Payers Consider Ideal for Health Information Exchange
  • Walgreens and Centura Health form healthcare partnership
  • Getting CAHs to attest to meaningful use
  • Value of meaningful use for rural communities
  • EHR System, Health IT Solution Earn ONC Health IT Certification
  • Hospital EHR Use Helps Improve Weekend Health Outcomes
  • ONC to accelerate meaningful use with State Challenge 2.0
  • mHealth prize goes to bipolar management app at Datapalooza
  • EHR Adoption and Meaningful Use at HIMSS15
  • EHR Improvements Needed to Improve Physician Productivity
  • Remote monitoring brings chronic disease management home
  • Kaiser, Mayo Clinic Make Hospital EHR Adoption Headlines
  • Task Force Grapples with HIT Product Comparison Framework
  • Apple Debuts Patient-Centered EHRs With Health Records App
  • HIM and HIT Fields Team Up on Interoperability Governance
  • Is virtualization the future of meaningful use?
  • 70% of providers try to cut costs in face of healthcare reform
  • OIG monitoring of meaningful use to include CEHRT security
  • ONC Finalizes Annual Advisory for Health IT Standards
  • Hospitals put off or don’t plan to conduct ICD-10 dual coding
  • AMIA Urges FDA Improve Clinical Decision Support Regulation
  • LOINC Director Advises Restraint in Health Data Standardization
  • Why mobile health first requires governance strategies?
  • ICD-10 Coalition opposes ICD-10 delay in SGR patch
  • Physician employment is high, but is satisfaction keeping pace?
  • HIE goes social: Will tibbr take off among physicians?
  • Top Inpatient EHR Companies by Hospitals
  • ONC Chief Science Officer Fridsma to depart federal agency
  • CMS resources aim to simplify reporting for quality programs
  • EHR Vendors Find Their Place Among Office-Based MU Providers
  • Medical scribes boost EHR productivity, streamline workflow
  • Senate steps up VA oversight as FBI opens criminal probe in AZ
  • The Week Ahead in Health IT Interoperability: Nov. 23-29
  • EHRs and meaningful use: Unintended consequences, unexpected possibilities
  • The ultimate health IT gift list for Christmas of 2013
  • CMS Adds More Quality of Care Data to Comparison Sites
  • Meaningful Use, ACOs Raise Health IT Integration Needs
  • Carequality, CommonWell Reach Health Data Exchange Agreement
  • AHIMA 2012: EHR and the physician experience
  • Most Hospitals Lagging Behind in Using Patient-Generated Data
  • How Meaningful Use, EHR, ICD-10 Implementation Fared in 2014
  • How Strong Health Data Governance Ensures EHR Data Integrity
  • Interoperability Bill Eyes EHR Oversight, Certification, Use
  • Basic Hospital EHR Adoption Rates Climbs to Nearly 75%
  • How Front-End Speech Recognition Adoption Impacts EHR Usability
  • Why EHR Interoperability Could Benefit from a SMART Approach
  • As CMS Becomes Lenient, Providers Tackle Patient Engagement
  • Best practices for hiring, managing health IT consultants
  • NFL team tackles concussions with EHRs, portable imaging tech
  • Surescripts National Record Locator Service Continues to Grow
  • HIE Partnership Targets Health Data Exchange, Population Health
  • CMS to Implement New Health IT Standard for Reporting eCQMs
  • Effective EHR use requires constant assessment
  • EHR data analytics help detect risk, outcomes of sepsis
  • Centura Health Receives HIMSS Davies Award for Health IT
  • Renewed Call for HHS Support to National Patient Identifier
  • Meaningful use at the speed of sound
  • Taking the physician perspective on EHR-HIT optimization
  • EHR Implementation Projects Impact EHR Optimization Efforts
  • Fee-for-Service Reimbursement Limits Telehealth Adoption
  • Resource Shortfall in Prevention of Health Record Duplicates
  • AHRQ to measure EHR effects on health literacy
  • How Population Health, Payment Reforms Impact Telemedicine
  • Physician series: Louis McIntyre talks meaningful use
  • 65% of patients think mHealth would keep them healthier
  • Leveraging Provider Communication for Better Care Coordination
  • VA uses EHRs, natural language processing to spot suicide risks
  • Docs Adapt Better to EHR Workflow Changes with Active Education
  • Allscripts Acquires HealthGrid, Grows Patient Engagement Platform
  • ONC provides HIE toolkit for rural providers
  • Humana begins remote monitoring, telehealth pilot
  • CommonWell comments on its role in HIE, interoperability
  • Kareo, McKesson Lead the Way in EHR and Health IT Systems
  • How does provider-developer collaboration improve health IT?
  • Researchers Propose ‘Health Information Exchange of One’
  • EHRs enable researchers to predict patient depression
  • Interoperability and HIE need to come standard
  • ePHI will benefit from more policy not just more technology
  • Specialist Physicians Counter Call for Eliminating MIPS
  • Fitch raises long-term EHR meaningful use concerns
  • ONC Awards $1.5M to Improving Health Data Exchange
  • IOM: Health IT Interoperability Factors in Diagnostic Errors
  • A CIO’s Take on Stage 2 Meaningful Use Requirements in 2015
  • ONC explores Blue Button access for immunization records
  • Two Adventist Hospitals Recognized for Exemplary EHR Use
  • Health IT Leader at Center of $800K Fraud Scandal in California
  • Congressional Hearing to Investigate Health IT Progress
  • Safety net ACOs lack necessary EHR functionality
  • Connectathon 2013 to test interoperability
  • AHRQ Review Finds Literature Lacking in Support of HIE Use
  • NY e-Prescribing Mandate Takes on Controlled Substance Abuse
  • IBM, Carilion Clinic detect patients with heart failure risk
  • The first provided information prompts for certain conditions (e.g., isolated tachycardia, isolated hypothermia). The second comprised diagnostic alerts for new positive sepsis screening results or indications of worsening sepsis for previously screen patients. The third category of alerts offered advice on evidence-based care sepsis care. Lastly, the four set of alerts reminded staff to acknowledge and comply with recommended treatment plans.

    As part of the sepsis surveillance system, nurses were responsible for alerting physicians about patients with sepsis diagnoses.

    The algorithms used as part of the surveillance had their roots based in work by both the Office of the National Coordinator for Health Information Technology (ONC) and Health Information Management Systems Society (HIMSS) for CDS implementation, which required adjustments to EMR data, namely clinical documentation.

    Improvement accuracy in identifying cases of sepsis was another benefit of the computerized approach at Huntsville.

    "The electronic system had excellent accuracy for detecting sepsis or severe sepsis, with sensitivity of 95% for sepsis cases and 82% specificity, compared to the gold standard of physician chart review," wrote Manaktala & Claypool.

    The authors credited the sophistication of the CDS system at the Alabaman hospital with demonstrating clear improvements over previous attempts at the same end.

    "The sepsis screening algorithms used in the current study were based on standard IHI guidelines," they claimed. "However, these algorithms also contained additional specifications to adjust for comorbid medical conditions and medications. We believe that the complexity of the system’s algorithms are responsible for its high sensitivity and high specificity and are key contributors to the impressive outcomes reported in our results."

    Likewise, the system avoided the pitfalls of alert fatigue previously associated with electronic surveillance systems.

    "Previous electronic surveillance systems have either had issues with high alert fatigue, when they have been successful in detecting sepsis (high sensitivity with low specificity), or have had modest alert fatigue, but missed a significant number of sepsis cases (high specificity, low sensitivity)," Manaktala & Claypool continued. "Likely as a result of this, previously published electronic surveillance systems have not been shown to have a significant impact on mortality."

    Underpinning the improvements at Huntsville were the use of four metrics:

    Sepsis mortality was reduced in the study group, based on four assessments: (1) measuring sepsis prevalence and mortality using ICD-9 codes for sepsis; (2) calculating sepsis mortality over a period of time; (3) calculating sepsis prevalence and mortality using Angus implementation criteria; and (4) measuring sepsis mortality after adjusting for patient-level parameters.

    According to the authors, the timeliness of clinical responses to sepsis diagnoses was the deciding factor in preventing sepsis mortality.

    X

    EHRIntelligence

    Sign up to continue reading and gain Free Access to all our resources.

    Sign up for our free newsletter and join 60,000 of
    your peers to stay up to date with tips and advice on:

    EHR Optimization
    EHR Interoperability
    EHR Replacement

    White Papers, Webcasts, Featured Articles and Exclusive Interviews

    Our privacy policy

    no, thanks

    Continue to site...