Use of Electronic Health Records and Clinical Decision Support Systems for Antimicrobial Stewardship
CID
Use of Electronic Health Records and Clinical Decision Support Systems for Antimicrobial Stewardship
Graeme N. Forrest 2 3
Trevor C. Van Schooneveld 1 2
Ravina Kullar 0 2
Lucas T. Schulz 2 5
Phu Duong 0 2
Michael Postelnick 2 4
0 Global Medical Affairs, Cubist Pharmaceuticals , Lexington, Massachusetts , USA
1 University of Nebraska Medical Center , Omaha , USA
2 Portland VA Medical Center , 3710 SW US Veterans Hospital Road, Portland, OR 97239 , USA
3 Division of Infectious Diseases, Portland Veterans Affairs Medical Center , Portland, Oregon , USA
4 Northwestern Memorial Hospital , Chicago, Illinois , USA
5 University of Wisconsin Hospital and Clinics , Madison , USA
Electronic health records (EHRs) and clinical decision support systems (CDSSs) have the potential to enhance antimicrobial stewardship. Numerous EHRs and CDSSs are available and have the potential to enable all clinicians and antimicrobial stewardship programs (ASPs) to more efficiently review pharmacy, microbiology, and clinical data. Literature evaluating the impact of EHRs and CDSSs on patient outcomes is lacking, although EHRs with integrated CDSSs have demonstrated improvements in clinical and economic outcomes. Both technologies can be used to enhance existing ASPs and their implementation of core ASP strategies. Resolution of administrative, legal, and technical issues will enhance the acceptance and impact of these systems. EHR systems will increase in value when manufacturers include integrated ASP tools and CDSSs that do not require extensive commitment of information technology resources. Further research is needed to determine the true impact of current systems on ASP and the ultimate goal of improved patient outcomes through optimized antimicrobial use.
antimicrobial stewardship; clinical decision support system; electronic health record
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Electronic health records (EHRs) and clinical decision
support systems (CDSSs) are playing increasingly
important roles in the delivery of healthcare services in
the United States [
1, 2
], and show potential for
furthering antimicrobial stewardship programs (ASPs). These
forms of technology are gradually transforming the US
healthcare system from one that is primarily paper
based to one that uses electronic technology to provide
clinicians with integrated information, enabling them
to deliver higher-quality and more efficient care [3].
In fact, the Centers for Medicare and Medicaid Services
(CMS) identifies EHRs as “the next step in continued
progress of healthcare” [
4
].
The primary purpose of the Health Information
Technology for Economic and Clinical Health (HITECH) Act
of 2009 was to encourage US physicians and hospitals to
adopt EHR systems [
5
]. An EHR is a longitudinal record
of patient health information generated by 1 or more
encounters in any care setting [
6
]. Through HITECH, the
federal government may disburse up to $27 billion in
incentive payments over a 10-year period, and may award
up to $44 000 (through Medicare) and $63 750 (through
Medicaid) to individual clinicians [
5
]. HITECH is also
making financial incentives available to qualified
institutions as they adopt, implement, upgrade, or show
“meaningful use” of certified EHR technology by meeting
several predefined objectives established by CMS [
7
].
Furthermore, the Institute of Medicine has identified EHR
functions that are necessary for improving patient safety,
supporting delivery of effective care, facilitating chronic
disease management, and improving efficiency [
8
].
These include health information and data, results and
order management, decision and patient support,
electronic communication and connectivity, administrative
processes and reporting, and population health.
Whether EHRs will meet the expectations for
improvement in patient care is yet to be determined, and
little literature has specifically evaluated the impact of
EHR introduction on antimicrobial use or appropriateness.
Although the currently available EHRs offer many practical
advantages, their impact on improving antimicrobial use and
infectious disease–relevant patient outcomes has been limited,
primarily owing to the paucity of included CDSS capability.
Although the widespread use of EHRs is a relatively new
phenomenon, third-party CDSSs have been used for many years to assist
both ASPs and clinicians implement processes consistent with
current clinical practice guidelines. CDSSs typically utilize
individual patient data coupled with population statistics and
computerized clinical guidance to provide patient-specific
management recommendations either on clinician request or at the
point of care. CDSSs have aided clinicians in selecting
appropriate antimicrobial therapy for various infections as well as in
avoiding preventable errors, and have been shown to improve
the overall quality of care [
5
]. CDSSs that have been integrated
into EHR platforms have been shown to enhance the quality of
clinical care and improve (...truncated)