Integrating Healthcare
Information Technology (HIT) into
Clinical Practice
David K. Ahern, PhD, Thomas C. Bailey, MD, Charles B. Eaton
MD, MS, David C. Goff, Jr, MD, PhD,
Jeffrey Rothschild, MD
For the Innovative Strategies Writing Group
Objectives
 Illustrate
approaches using information
technology to improve adherence to
guidelines
 Identify selected barriers and facilitators
for these approaches
 List some of the preliminary lessons
learned
Study Approaches Using HIT
Project
Project description
Technology
Assisted
Academic
Detailing (Bailey)
Cholesterol
Education And
Research
Trial (Eaton)
Automated ID of inpatient candidates for
primary and secondary CHD prevention
to facilitate academic detailing
Waiting room patient activation software
combined with PDA-based decision
support for cholesterol management
Guideline
PDA-based decision support and
Adherence for
academic detailing for cholesterol
Heart Health (Goff) management
Transfusion CDS CPOE-based decision support for
(Rothschild)
inpatient transfusions
TAAD, CEART, GLAD, T-CDS
CEART
Wagner EH. Chronic disease management: what will it take to
improve care for chronic illness? Eff Clin Pract. 1998;1:2-4.
Technology Assisted Academic Detailing
(TAAD) Bailey et al

Automated identification of inpatient candidates for CHD
prevention medications, coupled with pharmacistmediated academic detailing to improve adherence to:



CHD secondary prevention guidelines for patients with AMI
Cholesterol lowering guidelines for patients with diabetes
Patient identification using automated screening


CHD/AMI – troponin-based screening
DM – algorithm based on prior ICD-9, glucose, HA1c,
medications
Alert generated
from patient data
Pharmacist reviews
alerts and evaluates
for intervention
Pharmacist
approaches
physicians with
intervention
Barriers to TAAD
 Workflow

Timing of alert generation, response
 Short

issues
lengths of stay
Screening/alert to intervention time must be
efficient
 Personnel

issues
Prospective intervention requires personnel to
handle alerts
Facilitators of TAAD







IT infrastructure
Flexibility to adapt to workflow
Efficient methods of candidate identification
Dedicated pharmacist resources
Pre-existing pharmacist and physician culture
High profile issues of recognized importance
Both external and internal pressures to succeed
Lessons Learned from TAAD
 Technical
efficiencies make the impossible
possible
 Resource and workflow constraints are
critical considerations
 In asynchronous mode of decision
support, must make sure physicians follow
through
 A pharmacist champion coupled with
regular performance feedback is key
Cholesterol Education and Research Trial
(CEART) Eaton, et al
Pt activation tool
PDA Decision Support Tool with Patient
Education Screen
Barriers to CEART & GLAD
 Some
patients were not technology
oriented and wouldn’t use computer kiosk
(CEART)
 Varying physician experience with PDAs
and technology for decision support
 Physician workflow (and apparel) issues
Facilitators to CEART & GLAD




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Design and development of tools based upon
qualitative and formative research with patients
and physicians
Training and reinforcement in use of tools
Academic detailing regarding guidelines
Inclusion of other software (e.g, ePocrates)
Mobility and efficiency of PDA as a platform for
decision support tool
Appeal and ease-of-use of patient activation tool
(CEART)
Lessons Learned from CEART &
GLAD
 Both
patients and physicians need training
and reinforcement in use of technology
 Both technical and organizational
challenges need to be addressed
 Clinical decision support enabled by HIT
requires integration with workflow
Questions
?