Detection, management, communication enhanced
Having adequate information technologies and decision support systems (IT/DSS) in place can significantly enhance a hospital’s ability to respond effectively to a bioterrorism event, according to the Rockdale, MD-based Agency for Healthcare Research and Quality (AHRQ). The bad news? Only a small minority of hospitals have such systems in place.
The importance of adequate information resources was underscored in a new Evidence Report — Bioterrorism Preparedness and Response: Use of Information Technologies and Decisions Support Systems.
The study is part of AHRQ’s Evidence-Based Practice Program, through which it is developing scientific information for other agencies and organizations on which to base clinical guidelines, performance measures, and other quality improvement tools.
"The main reason IT and DSS, as well as other areas of bioterrorism response, are being studied by AHRQ is because we want people to be better prepared," notes Eduardo Ortiz, MD, MPH, senior service fellow at AHRQ.
A number of studies have shown that the use of IT in health care can reduce medication errors and improve patient safety, communication, patient self-management, and knowledge and adherence to recommended guidelines, Ortiz observes.
"IT can definitely be used to improve quality of care," he says. "There is so much information out there and a lot of research funded by AHRQ and others that shows that it does, so the natural evolution would be that if IT is useful in improving quality, it makes sense that it could be used in terms of bioterrorism."
Key points outlined
During the study process, the University of California at San Francisco-Stanford Evidence-Based Practice Center staff, along with an AHRQ task force, which included clinical experts, IT experts, and experts in epidemiology, asked and answered these key questions:
- What are the information needs of clinicians and public health officials in the event of a bioterrorist attack?
- Based on the information needs identified for these decision makers, what are the criteria by which IT/DSS should be evaluated with respect to usefulness during a bioterrorism event?
- When assessed by these criteria, in what ways could existing IT/DSS be useful during a bioterrorism event? In what ways is it limited?
- In areas where existing IT/DSS does not meet the information needs of clinicians or public health officials, what functional and technical considerations are important in the design of future IT/DSS to support response to bioterrorism events?
The report itself is quite lengthy — several hundred pages. But even the summary on the AHRQ web site is rich in detail gleaned from the existing literature. Accordingly, the report entails several key "take-home messages" for quality managers. (Go to www.ahrq.gov/clinic/epcsums/bioitsum.htm.)
Perhaps the most significant, Ortiz says, is the concept of dual-use, or multiple-use purpose.
"There are some systems already out there that enhance communication, detection, diagnosis, and so forth," he explains.
"Since they can be developed for clinical or public health reasons, why not tweak them for bioterrorism?" he asks.
"If you collect data in the clinic on patients who come in with certain symptoms, just make some adjustments so that you can communicate to public health officials or homeland defense," Ortiz points out.
More work needed
This would be more cost-effective than creating new systems from scratch, he explains.
"In some situations they would have to be designed specifically," he says.
The study found 217 IT/DSS that had the potential to help in bioterror response, although the majority were not designed specifically for bioterror, Ortiz says. "They are potentially useful, but we’re not sure yet. Still, they are important to look at it."
Much more work is needed in this area, and we must critically evaluate these systems, he adds. "We should take an evidence-based approach to assess these and other systems," Ortiz advises.
Meanwhile, he notes, a number of organizations are continuing to work on developing a national health information infrastructure, which should prove invaluable.
"Many federal agencies are working on it now, led by the National Committee for Vital and Health Statistics," he says.
Other agencies include AHRQ, the Centers for Disease Control and Prevention, the National Library of Medicine, and the Center for Medicare & Medicaid services, along with private-sector organizations such as the American Medical Informatics Association, the E health Initiative, and The Markle Foundation.
A long way to go
Unfortunately, Ortiz notes, the health care profession is behind the eight ball when it comes to IT development.
"We know that, in general, the majority of hospitals in this country do not have comprehensive IT decision support systems for clinical care," he says. "The estimates range between 5% and 30%, so I would say that probably somewhere in the vicinity of 10% of all hospitals have comprehensive systems, and that the number that have adequate systems for bioterrorism would be less than that — and these are inpatient systems.
When you go to the outpatient area, there are even fewer of them, even though the majority of health care is delivered in an outpatient setting," Ortiz says.
The good news is that if your current system is inadequate, there are opportunities to benchmark a number of hospitals/health care systems with good systems, he says.
- Regenstrief Medical Record System — Indiana University Health Care System;
- Health Evaluation Through Logical Processing — LDS Hospital in Salt Lake City;
- Brigham and Women’s Hospital in Boston;
- VA Health Care System;
- Department of Defense Health Care System;
- Kaiser Permanente Health Care System.
[Editor’s note: The full report is available free from AHRQ Publications Clearinghouse. Telephone: (800) 358-9295. Additional information on the linkage between IT/DSS and health care quality may be found in the following article:
• Hunt DL, Haynes RB, Hanna SE, Smith K. Effects of computer-based clinical decision support systems on physician performance and patient outcomes. JAMA 1998; 280:1,339-1,345.]