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All Things HIT

Aug 5 2011   1:48PM GMT

Clinical decision support systems and HIEs can play a critical role in reducing ER errors



Posted by: AllinHIT
CDS, CDSS, clinical decision support, ED, Emergency department, Emergency room, ER

One hundred twenty four million people are treated in hospital emergency rooms each year.  Unfortunately, there are common mistakes of diagnosis, which contributes to the ER department having the highest number of malpractice suits in the hospital.   There is no doubt that implementing HIEs and clinical decision support systems (CDSS or CDS) at the ER level can reduce the most common diagnostic errors, hence reducing costs, and saving lives.

Aon Corporation, one of the largest insurance brokers, estimates that hospitals spent roughly 1 billion dollars in 2009 for malpractice suits related to the emergency department.  Some of the most common mistakes are confusing indigestion with heart attacks, vertigo and migraines with stroke, viral gastroenteritis with meningitis, and heart attacks and seizures with pulmonary embolism.  Careful to not place blame and point the fingers solely at the doctors or the hospital, it was found that, it most cases, the doctor was missing some key information, not readuly available at the time or point of care. This “gap” of information usually pertains to medical history, abnormal vitals (usually because of a gap in communication) and untimely lab and radiology reports.

If it’s not obvious how CDSS and HIEs will address these concerns, let me attempt to explain.  One of the easiest reasons to digest concerns the lack of information.  By working with and implementing an HIE, the ER doctors will have pertinent, up-to-date information on the patient’s medical history.  Recent labs, allergies, meds, and diagnoses from their primary care physician is protected health information (PHI) that will allow the hospital to filter down to the correct problem, and possibly, hopefully, avoid spending critical time by not duplicating tests (whichi is also yet another cost savings!).  Implementing CDSS will also require the hospital to develop an “order set” for each leading misdiagnosis.

For example, if a patient complains of indigestion, muscle strain, or anxiety, the system will automatically task the hospital with performing an electrocardiogram.  You can easily tie the order set to symptoms, or even to a doctors diagnosis.  This intelligence will reduce errors, save time, and save money.  At a time where re-admissions are being challenged and accountable care organizations (ACOs) are forming, these systems and tools are crucial in moving us from a fee for service model to one of quality.

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