Home-grown CDR draws high utilization and award
Home-grown CDR draws high utilization and award
Stores 22.5 million clinical results on 2.2 million
An award-winning centralized database at Middlesex Hospital in Middletown, CT, not only has enhanced provider access to clinical data covering hundreds of thousands of patients, but it has provided the launching point for countless quality improvement projects, hospital officials say.
Launched in the mid-1970s, the goal of the initiative was to further develop the health system’s fledgling clinical data repository into a true a health information network (HIN) that could facilitate the creation, distribution, storage, and utilization of the clinical information cost-effectively to improve physician satisfaction, increase volume, and improve quality.
By 2002, when Middlesex vied for and won the VHA Northeast Innovation Award for Information Technology Enhancement, the clinical data repository (CDR) was storing 7.5 years of history on 302,000 patients, 22.5 million clinical results (an average of 74 results per patient) on 2.2 million patient encounters.
Today, according to Lud Johnson, MS, vice president of information services at Middlesex, it handles 1 million lab requisitions per year, 165,000 outpatient radiology results, and stores nine years of history with an average of 107 results per patient.
There are a total of 2,900 users — about 1,200 of whom are external, and all of whom can sign in through the system’s web browser. (For a more detailed breakdown of usage, see box, at bottom.)
"It’s hard to remember when we didn’t have it," says Susan Menichetti, MPA, president and CEO of Integrated Resources for the Middlesex Area (IRMA), LLC, Middlesex’s contracting and quality entity. "It is most readily acceptable in terms of the medical staff, for easing practice and improving access to information," she says.
"From an information systems perspective, it has become the most significant asset we have," Johnson adds. "It works as a community health record." (He notes that 60% of the hospital’s revenue is on the outpatient side.)
Building brick by brick
The database, as presently constituted, actually began development in late 1995, recalls Johnson. "We started off small; we basically just had lab results in the beginning," he says.
"Over the next three to four years, we added more content — all of the dictated reports we do in the hospital, discharge summaries, post-op notes, physical exams — anything that can be dictated to be part of the record — and for the pharmacy, anything we prescribed to patients while they were in the hospital," Johnson explains.
Over the years, other information was added, such as dictated radiology results, and then data from the emergency department (ED). "We do 80,000 visits a year, and all of those visits have a dictated report," he notes. Then came all the cardiology results.
"We decided that just the results were not enough, so we then added all EKG strips," says Johnson.
Next, it was decided there was not enough information on the ED, so a scanning system was added. "We now scan now over 5,000 visits a year," he points out. "Each visit is eight to 10 pages long, sometimes including information like advance directives."
In the past year, Middlesex has added a new PAX imaging system, which enables MRIs and CT scans, for example, to be archived into the system.
The users are separated into eight different caregiver categories, Johnson explains. "Each category has a different amount of access, with ED docs having the greatest amount of access."
A boon to QI
From a quality improvement perspective, the database "has been fabulous," Menichetti notes. "We continue to find uses for it."
For example, she says, Middlesex has many patients with chronic disease management issues.
"For diabetes, we create lab registries for all the docs, showing them which of their patients have diabetes results," Menichetti explains.
"The physician may realize they have not seen the patient for several months, see their hemoglobin A1c is high, and call them in. They can also farm’ the system to get patient IDs for disease management programs; if their values are out of whack, they can call [the program manager] to see if the patient could benefit from counseling," she continues.
Eliminating duplication of tests
The database eliminates duplication of tests, Menichetti adds, which eliminates the need for patients to be unnecessarily poked and prodded.
"In terms of continuity of care, you can tell if a patient has been to the ED, who else they have seen, and review all their records," she notes.
"You can also get their meds lists, allergies, the kinds of things that are embedded in an ED visit; there are often a lot of issues in terms of medication reconciliation," Menichetti adds.
Other tests also can help route patients to disease management programs or additional care, she says. "For example, with [abnormal] serum albumin, you can look at nutrition, dietitians, consider the patient for counseling," Menichetti adds. "There is a lot of applicability involving lab values showing the patient could be managed better."
Medication reconciliation, she continues, "is an enormous problem," but the pharmacy database can be a big help. "Patients who come into the hospital through the ED may not remember what meds they are on, or if they have recently been changed," Menichetti notes.
"The physician can use the database to validate [that information] and at the end of the stay double-check what they have been on and what they should stay on. Then, in follow-up, he can make sure the patient is not on duplicate meds; for example, they may have been on Coumadin, then put on the generic Warfarin, and they could be getting a double dose," Menichetti adds.
The only downside, if there is one, is that the system is so data-rich, it creates a challenge in the moving to computerized physician order entry (CPOE).
"We’re now moving to a Cerner system for CPOE," Johnson says. "We have 40 million clinical results, and we’re trying to figure out how to marry it with our system going forward.
Nevertheless, he insists, "Everybody should do this. You need access to a complete system so you have all the information that doctors need. Plus, your clinical data repository has to be as complete as possible to move into CPOE."
"Our physicians would probably lynch the administration if they could no longer have it," Menichetti notes. "It’s made such a difference in their practices."
Need More Information?
For more information, contact:
- Lud Johnson, MS, Vice President, Information Services, Middlesex Hospital, 192 Westbrook Road, Essex, CT. Phone: (860) 358-3700.
- Susan Menichetti, MPA, President and CEO, Integrated Resources for the Middlesex Area, LLC, Essex, CT. Phone: (860) 358-3700.
|
Middlesex Central Database Lookups by Security Roll by Year |
||||||||
|
1979
|
1998
|
1999
|
2000
|
2001
|
2002
|
2003
|
2004
|
|
| Ancillary |
10,000
|
5,102
|
6,561
|
12,489
|
31,933
|
40,903
|
58,986
|
66,446
|
| Ancillary + Nurse |
—
|
22,774
|
22,493
|
50,393
|
84,552
|
97,471
|
120,202
|
131,443
|
| Service |
—
|
3,254
|
3,158
|
5,154
|
891
|
492
|
381
|
294
|
| Nursing |
46,248
|
50,878
|
36,510
|
85,488
|
120,550
|
115,726
|
160,972
|
163,861
|
| Physician |
40,000
|
48,807
|
53,120
|
189,286
|
344,459
|
384,591
|
469,152
|
534,481
|
| Office Staff |
9,600
|
13,184
|
11,026
|
29,063
|
32,374
|
79,899
|
182,839
|
242,719
|
| Full Access |
49,100
|
75,922
|
38,422
|
87,192
|
128,733
|
98,563
|
154,085
|
185,504
|
| Total |
154,948
|
219,921
|
171,290
|
459,065
|
743,492
|
817,645
|
1,146,617
|
1,324,748
|
| Source: Middlesex Hospital, Middletown, CT. | ||||||||
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