The Future of Healthcare: Analytics, CDS and Sepsis
The future of health IT lies in its ability to aggregate and transform patient data and clinical content into actionable knowledge that can be used to improve clinical and financial outcomes. By layering analytics with clinical decision support (CDS) and surveillance, we can impact mortality and outcomes through early detection and by directing the most appropriate care.
The Power of Innovation
This is the focus of work underway today in the Wolters Kluwer Health Innovation Lab. Clinical, technological and informatics experts are seeking better ways to eliminate data silos and transform patient information and clinical content into knowledge that enhances clinical judgment and guides care decisions. Importantly, this is being undertaken in partnership with hospitals to better identify ways to normalize and codify patient data, aggregate it in the cloud, then run it against trusted clinical scenarios to create actionable, evidence-based advice that clinicians can access at the point of care using a variety of mobile devices—and do so in a way that does not add to alert fatigue.
The first solution to emerge from Innovation Lab is POC Advisor™ and the first application is helping to reduce mortality and morbidity of sepsis, one of the most important, deadly and undertreated diseases in healthcare today.
The impact of POC Advisor on sepsis as demonstrated by a pilot project currently underway at Alabama’s Huntsville Hospital will be the subject of a presentation during HIMSS15. “A Multidisciplinary Approach to Combating Sepsis,” which will be presented by Joycelyn Craighead, Huntsville’s Director of Quality, and Wolters Kluwer’s Stephen Claypool, MD, Medical Director of the Wolters Kluwer Health Innovation Lab, will take place April 14 from 4-5 p.m.
Improving Sepsis Outcomes
The body’s inflammatory reaction to infection that spins out of control, sepsis can lead to organ failure and death—and did so 260,000 times in the U.S. in 2009. According to “Surviving Sepsis Campaign: Association Between Performance Metrics and Outcomes in a 7.5-Year Study,” which appeared in Critical Care Medicine, three “effects” impact sepsis outcomes:
- The effect of participation in the Surviving Sepsis Campaign (SSC), which was an overall decline in mortality and suggested that participation in SSC alone is associated with improved patient outcome
- The effect of duration of participation was seen in a 7 percent decline in the risk of mortality for every additional quarter a site participates in the SSC. Longer participation resulted in better associated outcomes.
- Dose effect was seen in compliance as a continuous variable; for every 10 percent increase in compliance at a given site, the risk of hospital mortality decreased 3-5 percent, so the more compliant a hospital, the better the associated outcome.
When these “effects” are increased, treatment of sepsis will be greatly enhanced. To that end, POC Advisor combines three critical components:
- Change management
- Deep, up-to-date medical content
- Software to deliver decision support to the point of care
Building a Better System
When developing the sepsis module, we started with the Surviving Sepsis guidelines. We then included additional criteria to improve alert sensitivity and specificity, such as disease- and medication-specific rules to account for lab abnormalities. In all, there are hundreds of rules based on patient-specific variations within the sepsis module.
These sepsis rules are further tailored to each facility’s patient population and processes. A sampling of alerts is reviewed by clinicians for accuracy and the program is adjusted accordingly. It is a highly iterative process that is having the desired impact.
The POC Advisor study at Huntsville Hospital resulted in a 53 percent reduction in hospital sepsis mortality and about a 31 percent reduction in 30-day sepsis readmissions. There was also a downward trend in length of stay.
The implementation of this type of comprehensive IT platform holds significant potential for improving patient outcomes, hospital financials, and clinician performance. Though the current pilot focuses on the fight against sepsis, work is already under way within Innovation Lab to apply POC Advisor to MEWS (Modified Early Warning Score), and future applications are expected to include improving outcomes related to pneumonia, heart failure, diabetes, CLABSI (central line associated bloodstream infection) and CAUTI (catheter associated urinary tract infection).
POC Advisor exemplifies Wolters Kluwer Health’s goal of providing an integrated suite of services designed to improve care. More importantly, it demonstrates how leveraging health IT to disseminate patient-specific, actionable clinical knowledge across the care continuum will result in higher quality treatment and improved outcomes.