Clinical decision support systems in NSW are at a crossroads in their evolution – and key steps should be taken to ensure they are fit for purpose, the latest HARC forum has been told.
Professor Greg Maynard – a pioneer in the use of electronic medical record (eMR) systems to improve care quality in the US – told the recent Sydney forum that the great majority of NSW eMR systems did not currently record all of the important information that could significantly improve patient outcomes. But now was the time to act.
“I believe you’ve got a huge opportunity now before you start electronifying medical records further and getting the medication orders in place to decide what’s important to record, and to hard-wire that data into your systems,” he said.
“Ideally, you would define best practices for important conditions, and build clinical decision support and measurement to reinforce and monitor those best practices into standardized order sets and documentation in the eMR. With this kind of advance planning, you can hard-wire important data and reporting capacity into your systems.”
Professor Maynard, Director of the Centre for Innovation and Improvement Science at the University of California, was invited to Sydney by HARC partner the Clinical Excellence Commission to assess eMR systems in use here. He said his central message for NSW was not to wait to get robust eMR systems planned and rolled out.
Also Senior Vice President of the US Society of Hospital Medicine’s Centre for Hospital Innovation and Improvement, Professor Maynard told the forum there was currently no easy way in NSW eMRs to examine information about how many patients were taking certain medications, while other information was recorded but “extremely difficult” to extract.
It was important to have a clear idea of what issues needed addressing and what data should be recorded to assess those issues, he said.
He emphasised real institutional support and investment, good measurement tools and a system approach as being vital parts of an effective eMR system.
In response to Professor Maynard’s presentation, Professor Johanna Westbrook, Director of the Centre for Health Systems and Safety Research, said prescribing errors were a key area where eMR systems could improve patient outcomes.
The Centre, at the University of New South Wales’ Australian Institute of Health Innovation, studied two major teaching hospitals using an eMR system to see if the decision support it offered cut prescribing errors.
The system alerted doctors if a patient had recently been administered a prescribed drug, reducing duplicate therapy errors, and helped eliminate problems such as illegible handwriting on prescriptions.
Reduction in prescribing errors
“Overall, we found a 44 % reduction in serious prescribing errors in the intervention wards using the system,” Professor Westbrook said.
“We hadn’t expected this size of improvement, and this is where decision support really can be most targeted.”
Devising baselines measures and post-intervention measures was vital, she said, as well as the sharing of findings with other institutions.