Greater IT usage translates to better clinical outcomes

Hospitals whose intensive care units have more sophisticated electronic information systems are able to reduce central line infections more than hospitals with less automation. Central line catheters cause an estimated 80,000 infections-at an average cost of $45,000-and as many as 28,000 deaths each year in domestic ICUs.

"According to our findings, an ICU with a 10-point higher clinical information technology score is associated with 4.6 fewer central line infections per 1000 central line days compared with ICUs with lower IT scores that implement the same interventions," said Dr. Ruben Amarasingham, medical director at Dallas' Parkland Hospital and an assistant professor of internal medicine at the University of Texas Southwestern Medical Center.

The infection findings emerged from data accumulated by a new instrument (survey-based metric) designed to quantitatively evaluate ICU information systems across a broad range of hospitals. Amarasingham attributes the correlation between greater IT usage and lower infection rate results to highly automated, carefully designed information systems that may allow ICU teams to focus on truly clinical tasks by reducing paperwork, enhancing patient monitoring, and simplifying data extraction (J Am Med Inform Assoc 2007;14[3]:288-294).

While clinical information technologies such as PACS, electronic medical records, and computerized patient order entry systems may profoundly affect clinical performance, particularly in ICU settings, the degree to which these systems actually improve outcomes had proven difficult to assess prior to use of Amarasingham's survey instrument.

"We tried to develop a standardized method that can be applied widely to multiple ICUs to examine the capabilities and performance of clinical information systems," Amarasingham said.

Most examinations of IT capabilities have tended to be limited to a single site. Groups implement a PACS, an EMR, or CPOE, then present data from before and after.

"The other thing about those types of studies is that they tend to be done by individuals who are also involved in the implementation," Amarasingham said.

He said his methodology allows independent investigators to objectively compare multiple hospitals at one time and to examine IT performance against actual outcomes. Among other indicators, the instrument looks at the degree to which clinical processes are automated within hospital departments, including radiology-that is, the degree to which every single transaction is electronic.

The system also looks at consultation notes and whether physicians can access them electronically. A third domain is the degree to which order entry for medications, diagnostic testing, and consultation is automated.

"Based on all of those domains and subdomains, we are able to come up with a hospital's score on a 100-point scale," Amarasingham said.