St. James' Hospital and Cerner Develop System to Help Clinicians Diagnose Pulmonary Embolism
01 April 2011
DUBLIN — April 1st, 2011 — St. James’ Hospital and Cerner developed an interactive computerised decision-based ordering system to help clinicians accurately identify and diagnose pulmonary embolism (PE). PE has a 30 percent mortality rate if untreated and can be challenging to diagnose due to nonspecific and variable signs and symptoms. Clinicians utilise a medical diagnostic test referred to as a CT pulmonary angiogram (CTPA) which has been increasingly performed over the past decade. The Cerner decision support system helps relieve the demand for this test, reduce unnecessary radiation exposure and free up cost and time resources at the Hospital.
St. James’ conducted an audit to determine the current usage of CPTA scans at the hospital, to establish the positive rate of PE and to identify the risk factors. The results of the audit indicated several factors that increase a patients’ risk for PE including pregnancy, postpartum, malignancy, current or prior PE, current deep venous thrombosis (DVT), postoperative and immobile patients. The data was collected using the Cerner Millennium® system, a solution that collects, displays and manages vital patient images and information such as CT and MRI scans and fully integrates with the electronic health record (EHR). Out of 659 CPTAs conducted, only 11% were positive for PE.
In order to address this inefficiency, St. James’ worked with Cerner to develop an evidence-based process using decision support systems at the time of order entry. Using the risk factors identified during the audit and Well’s Criteria for PE, a clinical prediction score is calculated based on the PE presence probability. This score is automatically populated in the EHR using the interactive Cerner CPTA Advisor solution. Based upon the score, CPTA Advisor indicates whether or not PE is likely and recommends either proceeding with the CPTA or cancelling the order according to the level of risk.
After the implementation of CPTA Advisor, St. James’ conducted a second audit to access the impact. The results of the second audit indicated that there was an increase in scans that were positive for PE, indicating an increase in diagnostic efficiency over the previous audit. Additionally, 20% of CPTA scans were cancelled due to the decision support recommendation which allowed St. James’ to decrease unnecessary studies and inappropriate exposure to radiation. The successful implementation of the CPTA Advisor facilitated clinicians in applying the recommended guidelines for CPTA scans by incorporating decision support tools.
Professor Mary Keogan, Clinical Director of Radiology from St. James’ Hospital said:
"Working with Cerner we were able to create a customized clinical decision support system that not only allows us to incorporate evidence-based best practices into our workflow but also to save both time and cost associated with administering CPTA scans. Not only are we increasing our overall efficiency but we are benefiting the patient by avoiding unnecessary radiation exposure and increasing our diagnostic accuracy which ultimately leads to improved health outcomes.”
Amanda Green, Managing Director of Cerner Ireland, added:
"St. James’ is the first hospital in Ireland to develop automated clinical decision support; clinicians and patients are already benefiting from this ground breaking technology. Cerner will continue to collaborate with St. James’ to innovate and maximize the benefits of this technology so that St. James’ can improve patient outcomes and increase financial savings.”
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About St. James’ Hospital
St. James’ Hospital opened, in its current form, in 1971. St James’s Hospital has 837 beds and approx 4000 staff. In 2010 there were, 24,535 in Patient Admissions, 220,577 Outpatient Visits and 45,230 Emergency Department Visits. The hospital's fundamental purpose is the delivery of health treatment, care and diagnosis as well as health promotion and preventative services at catchment, regional, super-regional and national levels. Its service remits ranges in complexity from secondary to tertiary level. St. James's hospital is also an academic teaching hospital. It is thus committed to the creation of an environment and the circumstances in which education and research in the health science and allied areas is possible and flourishes. The hospital aspires to meet the highest possible standards and levels of efficiency, effectiveness and quality in all its endeavours. It is also driven by criteria of excellence, continuous improvement and innovation. Its services are made available equitably on the basis of need. Finally, the hospital is fully accountable to patients and other stockholders with respect to performance over the entire range of its remit.