If the concept of interventional informatics were sketched as a cartoon, the drawing might be that of a doctor hunkered in a bunker under a hospital peering intently at a computer screen. One of the physician’s hands would rest on an oversized emergency alert button attached to a big, red, flashing strobe light while the other grasped a telephone receiver.
While this is a parody of the principle, it does support the definition of interventional informatics: the remote detection of high-risk patient conditions coupled with the appropriate human intervention.
More explicitly, interventional informatics involves monitoring the conditions of high-risk patients electronically using online records stored in the laboratory information system, electronic medical record, and other clinical information systems. The systems generate simple medical care alerts, which are directed to a remote “informatics bunker” instead of to medical staff on the patient care floors. A physician informaticist working in the bunker analyzes the alerts to identify the potential for harm to a patient or instances where evidence-based care can be improved. If necessary, the informaticist then works with the patient’s primary caregiver to develop an appropriate intervention.
“It’s augmenting computer knowledge, computer alerts, with off-the-floor human skill so the alerts that are generated can be triaged and evaluated remotely in the overall context of patient care. So by the time an alert reaches the clinical floor, it’s of high relevance,” explains Mark Pierce, MD. Dr. Pierce is an independent information technology consultant. He also practices internal medicine and pediatrics at Parkview Health, a not-for-profit, five-hospital system based in Fort Wayne, Ind.
Dr. Pierce and former Parkview administrator Mark Clare coined the term interventional informatics two years ago after a patient nearly died from hyperkalemia. At the time, Dr. Pierce was chief medical information officer at Parkview and Clare was vice president of operational excellence. Hospital administration challenged the two men to find a better way to monitor patients rather than relying on the traditional approach of placing most of the responsibility on caregivers on the patient floors. Caregivers may be susceptible to “alert fatigue,” meaning they may ignore computer-generated alerts, Dr. Pierce explains.
Studies show that between 49 and 96 percent of patient alerts are ignored or overridden because they are not deemed to be significant or because they appear as false positives too frequently, Dr. Pierce says. Incorporating a human component, a monitor who weeds out the false positives and intervenes when necessary to prevent harm or improve care, is a way to leverage the use of expensive clinical information systems, he adds.
“Even some of the folks who’ve implemented these $75 million systems are finding that their clinical outcomes aren’t that much better,” says Dr. Pierce. “So I think the time is rapidly approaching where [people] are going to say, ‘What other models are out there?’”
Parkview Health implemented interventional informatics on a trial basis in October 2006. Today, 83 percent of the alerts generated within the system using interventional informatics are accepted by medical staff, Dr. Pierce says. Of the 17 percent that are ignored, most of the time it’s because the reason for the alert has already been addressed, most often by physicians making their rounds. “So that means we are saving lives,” he says. “And, indeed, this October we’ll celebrate our second anniversary of no code blues from hyperkalemia.”
The system is financially worthwhile as well. Based on labor costs for patient monitoring, triaging, and intervening, Dr. Pierce says, the health system needs to prevent about half of an adverse event per month to break even. “Right now, we prevent about 3.2 [adverse events] per month,” he says.
Because Parkview Health has had success with interventional informatics, Dr. Pierce is spreading the word to other health systems. To that end, he has formed his own company, Interventional Informatics, LLC, and is giving presentations to health care information technology groups, such as the Healthcare Information and Management Systems Society. Dr. Pierce believes the concept will take hold in the next 18 months or so as the health care industry explores ways to improve clinical outcomes through avenues other than relying on expensive technology.
“I think this is an alternative model that focuses on value that can make a difference for patients,” he says. “The fact that the economics support it so well and it’s so cost effective, that’s just icing. The bottom line is: Here’s a model that works.”
Healthvision has purchased the information systems division of MediSolution Ltd., Montreal, Quebec. The purchase excludes MediSolution’s blood bank product line and core resource management suite.
Healthvision, formerly Quovadx, has acquired MediSolution’s MediAR revenue cycle management product, as well as its electronic health record sys-tems, patient management suite, clinical department systems, lab information systems, and public health and community care solutions.
The purchase allows Dallas-based Healthvision to expand its reach in the Canadian health care marketplace.
Healthvision, Circle No. 186
MediSolution Ltd., Circle No. 187
Global Med Technologies, the parent company of Wyndgate Technologies, has purchased from eDonor its Web-based donor relationship management system, also named eDonor. The system integrates recruitment, scheduling, retention, and fulfillment for national and local community blood centers.
“With eDonor, we can now deliver a turn-key, fully integrated suite of products that eliminates the complexity and risk of Global Med’s integration while lowering the total cost of ownership,” says Thomas Marcinek, Global Med’s president and chief operating officer. The acquisition brings to 13 the number of Global Med software applications geared specifically to donor centers and hospitals.
Global Med’s European software subsidiary, Inlog, SA, will introduce the eDonor system inter-nationally.
Global Med Technologies, Circle No. 188
Novovision has introduced a secondary report interface module for its NovoPath anatomic pathology laboratory workflow management, specimen tracking, and reporting platform. The module attaches supportive information from a range of laboratory solutions to NovoPath patient files and seam-lessly integrates the information into comprehensive NovoPath anatomic pathology reports.
The new module supports solutions from vendors such as Ventana and Access Genetics and formats ranging from PDF and JPEG to DICOM. The NovoPath reports can be printed and faxed or transmitted directly into an electronic medical record system.
Novovision, Circle No. 189
Opus Healthcare Solutions has introduced the latest version of its OpusLaboratorySuite lab information system. The new release includes remote re-porting, allowing physicians to view results on a smartphone or PDA via a cell phone network or a hospital’s wireless connection.
“The smartphone capability enables clinicians to quickly scroll through results and view data from a variety of screens or information sets instead of having to wait for a static document sent by fax or e-mail,” says Fred Beck, president of Opus.
OpusLaboratorySuite can be integrated with most major hospital information systems and is available as an installed product or application service provider offering. New features of the system include rules-based reporting, quality control prompts, call management, and enhanced integrated data ex-port to Microsoft Office.
The LIS contains modules for clinical microbiology, anatomic pathology, and management reporting with data mining. It is fully integrated with the OpusClinicalSuite series of Web-based products, which includes systems for clinical documentation, order management, computerized physician order entry, medication administration, and Web portals for remote physician access.
Opus Healthcare Solutions, Circle No. 190
The International Health Terminology Standards Development Organisation has released enhancements to SNOMED Clinical Terms, or SNOMED CT.
The latest SNOMED CT release includes:
- improvements to the definitions of concepts in the specimen hierarchy. Fully defining concepts allows automated processes to place concepts in the hierarchy appropriately.
- the addition of more than 2,000 new organisms to the organism hierarchy, as requested by public health authorities, including the Centers for Disease Control and Prevention.
- implementation of standard naming conventions and consistent definitions for new imaging procedure concepts to allow for easier data retrieval.
- The inclusion of dose forms, such as oral dosage, in many concept definitions in the pharmaceutical/biological products hierarchy. This enhancement improves a physician’s ability to identify specific drug products that have multiple dose forms and allows decision support systems to more readily differentiate between these forms for treatment, contraindications, and adverse effects.
SNOMED CT is a standardized clinical terminology that aids in capturing, exchanging, and aggregating health data. The latest release of the product includes more than 315,000 active concepts, 806,000 active descriptions, and 945,000 defining relationships.
SNOMED CT is owned by the Copenhagen, Denmark-based International Health Terminology Standards Development Organisation, or IHTSDO, and developed and maintained by SNOMED Terminology Solutions, a division of the College of American Pathologists.
IHTSDO, Circle No. 191
3M Health Information Systems recently introduced computer-assisted coding software, 3M Codefinder computer-assisted edition.
The application analyzes and interprets text from multiple documentation sources, including electronic records and dictated and transcribed reports, for a hospital inpatient. Terminology mapping tools link textual data for coding to the logic-based coding paths of the 3M Coding and Reimbursement System. The application then suggests appropriate codes to coders and identifies missing documentation, such as diagnoses.
Codefinder can be integrated with 3M’s dictation, transcription, and speech-recognition software as well as chart-management and viewing applications. It can also be interfaced with software from other companies.
3M Health Information Systems, Circle No. 192
Data Innovations has released version 8.07 of its Instrument Manager rules engine, which includes a new archiving feature, redesigned rules interface, and enhanced backup functionality. Free upgrades from previous Windows versions are included in the company’s support and maintenance programs.
Archived data viewable in Instrument Manager can now be sorted, cataloged, and stored as PDF files for long-term offline storage. The redesigned graphical user interface is accessible concurrently by multiple users. Rules can be created and edited by free-text typing or via drag-and-drop from a tool-box. The new version also offers a library of rules and the concept of using value lists within rules.
Enhanced testing of rules allows users to build test suites of data, save them, run them through the rules, and save the output. The rules engine includes separate test and live rule sets, and rules can be transferred easily from one environment to the other. Furthermore, users can now back up set database files manually or automatically at user-defined days and times on any network drive or device without system downtime.
Data Innovations, Circle No. 193
Cognition Technologies has introduced Semantic Medline, a database of 18 million article abstracts published by the National Library of Medicine.
Users of the free service, available at www.semanticmedline.com, can employ a natural, conversational sentence structure to find studies of highly complex health information within the Medline data set.
The Web site is powered by Cognition’s Semantic NLP natural language processing technology, which incorporates word and phrase knowledge to comprehend the meaning and nuances of the English language. Therefore, the search process is based on meaning rather than statistical word-pattern matching. Unique to Semantic Medline, says Scott Jarus, CEO of Cognition, “is an understanding of synonymy and the ability to understand meaning and context reasoning.”
Cognition Technologies, Circle No. 194
Dr. Aller is director of automated disease surveillance and team lead for disaster preparedness Focus B, Los Angeles County Department of Public Health. He can be reached at email@example.com. Hal Weiner is president of Weiner Consulting Services, LLC, Florence, Ore. He can be reached at firstname.lastname@example.org.