Use of Electronic Health Records and Clinical Decision Support Systems for Antimicrobial Stewardship

Clinical Infectious Diseases, Oct 2014

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.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

https://cid.oxfordjournals.org/content/59/suppl_3/S122.full.pdf

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 - 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)


This is a preview of a remote PDF: https://cid.oxfordjournals.org/content/59/suppl_3/S122.full.pdf

Graeme N. Forrest, Trevor C. Van Schooneveld, Ravina Kullar, Lucas T. Schulz, Phu Duong, Michael Postelnick. Use of Electronic Health Records and Clinical Decision Support Systems for Antimicrobial Stewardship, Clinical Infectious Diseases, 2014, pp. S122-S133, 59/suppl 3, DOI: 10.1093/cid/ciu565