October 28, 2011

Fighting sepsis with health IT

Sepsis, which used to be called blood poisoning, is a life-threatening disease that arises when the body’s response to infection injures its own tissue and organs. It affects nearly 750,000 Americans annually, resulting in a mortality rate of almost 29%. Recognition of potentially septic patterns within the first two hours of their appearance is vital to the survival of the patient.

Cerner developed the St. John Sepsis agent in order to help clinicians recognize these patterns and get patients the treatment they need. Heartland Health in St. Joseph, Mo., was one of the first health care organizations to begin using the agent. Joe Boyce, CMIO at Heartland Health, recently shared some insight on why his organization decided to use the agent, and the benefits they’ve seen to this point.

How does early detection enable Heartland Health to better treat, and even prevent, sepsis?

Sepsis signs can be subtle, but automated monitoring of key elements can help identify problems hours earlier. Scrubbing a few hours off antibiotic administration for a septic patient can save organs and lives. This is a proven alert, the precursor of many in the field of clinical decision support. Basically, rules makes it “ok” for the nurse to call the physician with a consistent, coherent, scripted message, which makes it better for all involved – physicians, nurses, and most importantly, patients.

How will the St. John Sepsis agent help Heartland standardize care for septic and suspected septic patients?

The agent lets the tireless computer monitor the patient and alert human caregivers for consideration of a patient who may be on the brink. With the huge data load we are asking new clinicians to process, the computer “having my back” is essential for consistent, safe care. Someday soon, it will be malpractice not to have these systems in place.

Does Heartland currently have a sepsis monitoring system in place today? If so, how much time was/is spent researching, developing and maintaining the entire alert protocol? What are the comparison metrics regarding the sensitivity and specificity of the alerts?

We had previously done an ED sepsis look, and that helped us understand the benefit and complexity of the rule build and information/alerting process. Rules are just half of it – notifying the right caregiver and making the right response easy is also key.

Do you foresee a financial impact (positive or negative) due to additional diagnosis capture, based off of the St. John Sepsis early warning alerts?

We have already shown ROI from our ED rule in improved coding and earlier discharge.

What led your organization to work with Cerner and use the St. John sepsis agent?

We jumped at the opportunity, given the clear benefits of centralization for rule development, scalability, support and much larger volumes of comparison data across multiple clients. This is just the beginning for centralized CDS.