Semantic Interoperability Transforms Quality and Safety Efforts
March / April 2009
Semantic Interoperability Transforms
Quality and Safety Efforts
With the click of a mouse, comprehensive medical data from disparate systems becomes accessible at the point of care.
If you ask any healthcare provider about the most effective ways to improve patient safety, it’s highly unlikely that you would hear him or her say, “I’d like to know less about my patients before I treat them.” In fact, most clamor for all the information they can lay their hands on. Healthcare facilities and physician practices recognize that the more they know about a patient’s medications, allergies, current conditions, and medical history, the better able they are to deliver timely, effective care.
Fortunately, healthcare currently generates unprecedented volumes of medical data — thanks to today’s highly sophisticated diagnostic tools, technology with which to store and display results, and an ever-expanding array of treatment options.
But the accumulation of this data nevertheless falls short — simply because it is not routinely available, accessible, or applicable at the point of care. There are two primary contributors to this chasm between the existence of information and its utility in the delivery of care: 1) Patients are increasingly mobile, and rarely see their “family doc” at all stages of life, and 2) The trend towards specialization and sub-specialization means patients are treated by numerous caregivers over time and even over the course of a single episode of care. As a result, all of the valuable data that is amassed ends up scattered among various physicians, institutions, and health systems, where it is stored in discrete silos.
Unified Patient Records Offer ‘Meaningful’ Information
The realization that a fractured approach to patient information hinders the quality and safety of care has prompted healthcare thought leaders to explore options for data integration. Early models have included secure portals, interface engines, and the adoption of monolithic technology systems within a provider network. Each of these approaches has fallen short, however. Portals enable physicians to view information, and interfaces permit data to be exchanged, but neither allows the information to actually be incorporated with other data sets. Single-source systems require the premature and costly sunsetting of existing technology, and may preclude adoption of best-of-breed solutions ideal for specific user groups.
One alternative is proving to be much more valuable: Interoperability platforms enable a comprehensive, current medical record — in essence creating a unified record from various sources that generate patient data, no matter what format they are stored in or where they are located. Even more advantageous is semantic interoperability, which allows systems to truly understand and make use of the incoming data. In other words, semantic interoperability enables users to do more than simply import and review information from disparate software. It preserves the original meaning of the data and integrates the information for comprehensive analysis and trending, which enhances the provider’s diagnostic and therapeutic decision-making.
What does all this mean? That providers are not only able to see, but also to use, patient information that may have been gathered, for example, at the primary care physician’s office, in the Coumadin clinic, during an ED visit, and throughout an inpatient stay, with the simple click of a mouse.
Lives Saved Because Information Is Instantly Available
Early in 2008, the University of Pittsburgh Medical Center (UPMC) went live with the interoperability platform developed by dbMotion and invested in the company in line with UPMC’s strategic business initiatives. In one short year, UPMC has reaped tremendous quality and safety benefits from the technology. Consider these actual case studies — making an immediate and positive impact from the very start:
- The first day of the platform’s implementation, a young man was brought to the emergency department at UPMC Presbyterian Hospital after a late-night altercation. He was unconscious and bleeding profusely. The ED physician checked for a history through the Cerner FirstNet® medical record system, but found no information since the man had never been admitted. By selecting the interoperability icon on the computer screen, however, the physician immediately had access to comprehensive outpatient and lab records and discovered the patient was HIV positive. He immediately altered the care plan to take proactive steps to prevent infection, which could have immediate and possibly life-threatening consequences for this particular patient. In this case, the availability of complete medical records most likely impacted the man’s long-term survival.
- During the fall of 2008, a middle-aged gentleman was seen in the ED at UPMC St. Margaret Hospital, presenting with abdominal pain. Because abdominal pain may be attributable to something as simple as gas or something much more serious, ED physicians typically order a progressive workup to determine the cause of the discomfort — investigating simple explanations before considering more severe possible causes. Again, FirstNet showed no history, and the patient was not forthcoming with any beneficial information. The ED physician, however, accessed the dbMotion interoperability platform and found that the patient had a history of abdominal aortic aneurysm (AAA) and ordered a stat CT scan. The imaging study revealed that the AAA was leaking, and the patient was airlifted to UPMC Presbyterian Hospital where emergency surgery saved his life. There is no doubt in any of the caregivers’ minds that this patient would have died if the AAA had not been discovered and repaired as quickly as it was.
- The platform has proven invaluable in the ambulatory setting as well. An elderly gentleman with a history of prostate cancer scheduled an annual checkup with his primary care physic ian last summer. Before performing a routine prostate exam, the primary care physician reviewed the patient’s EpicCare ambulatory patient record, which documented no allergies to latex. The physician, however, also accessed UPMC inpatient records through the interoperability platform and discovered that a severe allergy to latex had been recorded during an inpatient stay — a condition the patient had not thought to mention. While the use of latex in this instance would not have been life-threatening, it most certainly would have resulted in an extremely uncomfortable exam (and a miserable patient).
Technology Overcomes Information Overload
Semantic interoperability has contributed greatly to patient safety in significant ways.
As any physician or clinician can tell you, medications are described by many different monikers. When recording an allergy to penicillin, for instance, physicians may represent the medication as “penicillin,” “pen.,” “PCN,” or ampicillin, to name a few. This makes reconciling a list of drug allergies extremely difficult.
Semantic interoperability overcomes this barrier, however, by translating the disparate representations into a universal language, so to speak. It consolidates all references to the medication under a single heading, “allergy to penicillin.” If the physician wants specific detail, he or she can then build out the list to see what various notations other caregivers have recorded.
Similarly, semantic interoperability can be used to combat “electronic system fatigue,” where too much information can overwhelm a clinician. A prime example is a patient’s medication list. When all episodes of care are combined, a single patient record may include 80 or 90 lines of information about drugs prescribed: type of medications, generic and brand names, dosages, times when they were prescribed, and so on. Even if a particular medication was administered only once, it appears on the list. It is all too easy for a provider to overlook or misinterpret the meaning of all this data when trying to review the comprehensive list at the bedside or in the exam room.
UPMC has launched a pilot project to address this concern. Semantic interoperability is being used to consolidate long lists of medications under a limited number of categorical headings. For instance, the medication list for a cardiac patient might be arranged by several therapeutic categories. Examples would include statins, beta-blockers or lipid lowering drugs, and anti-hypertensives. Treating physicians are then able to drill deeper into categories of interest for greater detail, such as dosage history. So far, physicians involved in the pilot believe that the risk for error drops significantly if they are no longer forced to hunt through this volume of information. The consolidation provides a snapshot that allows them to delve only into types of medications that may affect current treatment decisions.
Interoperability Enhances Efficiency and Quality
Finally, interoperability has also proven to enhance quality of care at UPMC during screenings prior to elective surgeries. To ensure the medical stability of the patient, nurses and other caregivers invested a great deal of time and effort “hunting and gathering” histories, lab results, imaging studies, and other important information from disparate clinical systems. This information needs to be available to both the surgeon and the anesthesiologist before the procedure can be undertaken.
UPMC conducted time studies pre- and post-implementation of the dbMotion interoperability platform at UPMC Magee to determine if it could make this process faster and more accurate. The research revealed that use of the interoperability platform effected an 82% reduction in time required to gather this information and a 50% increase in the number of patients who were ready for surgery with appropriate clearances at the time the surgery was scheduled.
While the interoperability platform utilized at UPMC has been in operation only since February 2008, the benefits to quality of care and patient safety are unmistakable. This advanced technology has already proven to be a effective tool in helping the organization achieve its objective of ensuring that the right patient receives the right care at the right time, every time.
Tami Merryman is chief quality officer for the University of Pittsburgh Medical Center. She may be contacted at merrymante@upmc.edu.