Although Beth Israel Deaconess Medical Center is very familiar to most IT professionals, the medical center continues to impress the healthcare industry with innovations in patient care. The organization's latest initiative--to create what CIO John Halamka, M.D., calls “event-driven medicine”--is no exception.
Like many other health systems, BIDMC is faced with a barrage of digital data that can easily overload clinicians as they try to find the most relevant information needed to treat the patient in front of them. The medical center currently holds 3 petabytes of patient data, which is equivalent to the entire content of the Library of Congress. Turning that much data into actionable information poses a real challenge for even the most sophisticated IT system.
To solve this problem, Halamka and his team have created systems that allow physicians to see the most important events in the patient’s record, so that they now have what Halamka likes to call “actionable wisdom.”
Physicians Need Triggers To Guide Their Actions
“If you ask clinicians in the 12 minutes they have to see a patient, document a patient, achieve 43 quality measures, practice perfect evidence-based medicine, and achieve Meaningful Use by weeding through 3 petabytes of data, it’s not likely to happen,” says Halamka. To help solve this problem, BIDMC has been working on a TRIGGER program, which makes use of an algorithm that will detect major variances, or events, in a patient’s physiological parameters—a sudden drop in blood pressure, or a pulse of greater than 120 for more 8 hours, for example. In event-driven medicine, the BIDMC team builds rules that allow computer systems to detect red flags from the mountains of incoming data and then alert the clinician of the need to take urgent action.
Many healthcare organizations in the United States are adopting a trigger-type early response system, particularly in the pre-ICU arena, says Qi Li, MD, Physicians Executive at InterSystems. “Pre-ICU management is very critical and directly impacts mortality [and] the financial returns are very compelling.” His company provides some of the technology that allows critical data from bedside monitors to reach the rapid response team quickly.
In addition to detecting urgent events, the TRIGGER system at BIDMC is also capable of giving clinicians reminders when they need to offer preventative care, based on the latest evidence-based clinical guidelines. So, for example, when a 50-year old patient walks into his primary care physician’s office, the system will alert that doctor that it’s time to recommend a screening colonoscopy to detect early onset colorectal cancer.
“There are thousands of piece of data to contend with but if you build alerts and reminders into your organization’s IT system, then suddenly the doctor is delivering high-quality, safe care and the computer system in really helping to focus their efforts” explained Halamka. During his keynote presentation at the IHT2 Conference in Boston, entitled “Health IT in a Healthcare Reform World: Connecting Patients, Providers and Payers,” he plans to go into more detail on how this system works.
The Patient and Family ICU Dashboard
That same presentation will touch on a key pain point for many clinicians and patients, namely finding ways to get patients and their families more involved in the medical care. All too often, asking the doctor how your father is doing since being admitted to the hospital generates responses like: His kidney readings are too low, or his cardiac enzymes aren’t where they should be. What families really need is a holistic view of the patient’s status. And BIDMC is working to make that happen.
With the help of a grant from the Gordon Moore Foundation, the medical center is creating patient dashboards. That will allow family members to walk into an ICU and see a comprehensive picture, including heart, kidney, and lung function, as well as a color-coding system using green, yellow, and red to explain the trends in the patient’s organ systems and overall status.
Beth Israel Deaconess Medical Center remains at the forefront of healthcare IT and clinical medicine by never shying away from seemingly intractable problems. And there’s much that other providers can learn from the way it is solving the data overload dilemma we now face. Three take home messages emerge from their work:
- Clinicians can’t practice individualized care if they have to wade through unmanageable mountains of data.
- Event-driven medicine requires an IT program capable of pulling out actionable clinical data that can be quickly brought to the physician’s attention.
- The families of ICU patients need to see a holistic picture of their loved ones’ condition through the use of a dashboard that quickly sums up the patient’s status.
Anything less isn’t really patient-centric care.
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