MedCentral Health System
Using Artificial Intelligence Software as a Clinical
Decision Support Tool for Laboratory Results: First
Increased Troponin – I Alert Project
Fred Crowgey, MBA, M(ASCP), Karen Phalor, MT
(ASCP), Eugenio Zabaleta, PhD, J Burgess, MD, M.
Patterson, DO, CMIO
MedCentral Health System
• 18,000 admissions
• 9,000 surgeries
• 70,000 emergency visits
• 300,000 outpatient visits
• 1,400,000 lab tests
• 160,000 radiology procedures
• 380 open heart surgeries
MedCentral Health System
• In 2007, the medical staff at MedCentral
Health System expressed the need for both
the laboratory to identify clinically significant
cardiac Troponin results and a system to relay
that information to the care provider in a
timely fashion.
• Even though human communication has
historically been the cornerstone of patient
care, it can be enhanced by IT.
Troponin I
Troponin Values (A30B)
12
11.385
10
ng/ml
8
6
5.849
5.036
4.404
4
2.728
2.795
2.7
2.015
2
0
2/19/2007
2/20/2007
2/21/2007
2/22/2007
2/23/2007
2/24/2007
2/25/2007
2/26/2007
2/27/2007
Proposed Solution:
• MedCentral would/has incorporated the Decision Tool
– PKS RippleDown®/LabWizard® - supplied by Pacific
Knowledge Systems into the MedCentral Enterprise
Information System (EIS).
• Within RippleDown®, specific rules were constructed
for the purpose of providing clinically relevant alerts
based on the outcome of current and previous testing
for each patient to warn physicians of potential issues
with their inpatients.
• Consistent application of clinical knowledge through
RippleDown® eliminates "human errors".
Actions
• Within PKS RippleDown®, specific rules were
constructed for the purpose of providing clinically
relevant alerts based on the outcome of current and
previous lab tests.
• Configured LIS for “Interfaces” and alerts.
• Stored Procedures for OpenLink Integration Engine.
• Consistent application of clinical knowledge through
IT eliminates "human errors".
IT Design Outcome
• Design: or Process
• MedCentral Laboratory is able to identify the First increase
in Troponin-I above the WHO (World Health Organization)
cut off (0.780 ng/mL)
• When the first increase of Troponin-I occurs RippleDown®
will send an alert message to the lab information system
(NOVIUS). The performing lab professional then will call the
clinician for that patient and communicate the increase of
Troponin-I. The nurse will then phone the physician.
• The results will also be communicated to the attending or
consulting physician through SOARIAN Clinicals in the Alert
section through Rules and Workflow software.
Test Ordered
(LIS)
Lab
Result
T
Test
Performed
Result Reviewed
By Rules Engine
Tech Notified to call
clinician
Result
Posted
(CDR)
Alert Posted
Rippledown® Overview
•
•
•
•
•
Decision support software which works on “cases”
Rules built by clinical staff, not IT
Pathologists/clinicians/researchers (users) able to:
– create and maintain their own Knowledge Bases
– implement their own interpretation of evidence based guidelines
– implement their local reporting preferences
– control their own workflow
Considers historical data and trends
Rules can access all relevant data
– Past test results
– Clinical data
– Patient and doctor demographics
– Previous report comments
Results
• MedCentral laboratory has performed 1618 Troponin-I
tests in the inpatient population on the month of April
2010, 53 of them were classified as a first Troponin-I
increase by RippleDown®.
• Data was gathered from NOVIUS® Lab, Soarian®
Clinicals, Rules and Workflow engine and RippleDown®
to analyze the implementation of the Troponin-I Alert
Project and its clinical impact.
• There is sufficient documentation showing that from
the 53 phone calls to the physicians due to Troponin-I
increase, 25 generated new treatment orders at the
time of the call.
Conclusion
• In conclusion, there is enough documented
data that the First Increased Troponin-I Alert
Project is improving communication of
information without replacing the critical
thinking or decision making of the patient care
providers or adding unnecessary phone calls.
Further clinical outcomes remain to be seen.
Keys Point
– No human intervention to generate alerts.
– System runs 24/7/365
– Process generates a phone call to appropriate
clinician
Pilot Tests
• Troponin
• Chem 8 Delta checks (Gluc, BUN,
Creatinine, Calcium, Na, K, Cl, and CO2)—
Identify clinical shifts in analytes
• H & H—
• WBC
• Lipid Profiles
Independent Physician Survey
• 350 Hospitals
• MedCentral Laboratory Ranking:
• 82.8 Percentile
MedCentral Health System
Questions?