Automated before-procedure electronic health record screening to assess appropriateness for GI endoscopy and sedation.

BACKGROUND Endoscopists are performing greater numbers of procedures, often on patients with complex conditions, in ambulatory settings because of changing patient demographics and referral patterns. To assist with the pre-procedure assessment of such patients, we deployed an advanced electronic health record tool, the Queriable Patient Inference Dossier (QPID), to review clinical histories and generate e-mail alerts to providers, based on clinical guidelines. OBJECTIVE Study the feasibility of an automated pre-procedure alert system for outpatient endoscopy. DESIGN We retrospectively reviewed 5 physicians' use of the application and their responses to the alerts. SETTING A hospital-based endoscopy unit and its two satellite outpatient clinics, Boston area, Massachusetts. PATIENTS Adult outpatients referred for endoscopy with moderate sedation. INTERVENTION Pre-procedure alerts automatically sent 7 days before the procedure, highlighting any conditions/clinical history that may affect management of the patient. MAIN OUTCOME MEASUREMENTS Physician use of the pre-procedure alert system and its effect on patient management. RESULTS We studied 1682 procedures that met inclusion criteria for review by QPID and 364 alerts (1.6% of the eligible procedures). Nearly 80% of the alerts were reviewed and responded to by the physicians, and 70 total alerts resulted in a change in patient management (4.2% of eligible procedures). LIMITATIONS The small size of the study group and the low rate of adverse events during the study period limit our findings. We thus plan to conduct a larger follow-up study to demonstrate changes in safety and efficiency. CONCLUSION Use of advanced electronic health record technologies, such as QPID, may improve provider efficiency and patient outcomes in endoscopy units.

[1]  D. Blumenthal,et al.  Information technology comes to medicine. , 2007, The New England journal of medicine.

[2]  A. Barkun,et al.  The future of academic endoscopy units: challenges and opportunities. , 2010, Gastrointestinal endoscopy.

[3]  M. Sivak,et al.  Use of open access in GI endoscopy at an academic medical center. , 1999, Gastrointestinal endoscopy.

[4]  V. Herasevich,et al.  Derivation and validation of automated electronic search strategies to identify pertinent risk factors for postoperative acute lung injury. , 2011, Mayo Clinic proceedings.

[6]  D. Kareken,et al.  Propofol versus midazolam/meperidine for outpatient colonoscopy: administration by nurses supervised by endoscopists. , 2002, Gastrointestinal endoscopy.

[7]  Felicia M Bowens,et al.  Health information technology: integration of clinical workflow into meaningful use of electronic health records. , 2010, Perspectives in health information management.

[8]  Ricky K. Taira,et al.  Context-Based Electronic Health Record: Toward Patient Specific Healthcare , 2012, IEEE Transactions on Information Technology in Biomedicine.

[9]  Ashish K. Jha,et al.  Electronic health records in small physician practices: availability, use, and perceived benefits , 2011, J. Am. Medical Informatics Assoc..

[10]  R. Mitty,et al.  The pre- and postprocedure assessment of patients undergoing sedation for gastrointestinal endoscopy. , 2008, Gastrointestinal endoscopy clinics of North America.

[11]  S. Mattke,et al.  Utilization of anesthesia services during outpatient endoscopies and colonoscopies and associated spending in 2003-2009. , 2012, JAMA.

[12]  R. Beart,et al.  Impact of the Aging Population on the Demand for Colorectal Procedures , 2009, Diseases of the colon and rectum.

[13]  Michael Zalis,et al.  Advanced search of the electronic medical record: augmenting safety and efficiency in radiology. , 2010, Journal of the American College of Radiology : JACR.

[14]  H. Mcdonald,et al.  Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. , 2005, JAMA.

[15]  William F Bria The electronic health record: is it meaningful yet? , 2011, Mayo Clinic proceedings.

[16]  Daniel M. Stein,et al.  Research paper: Quantifying clinical narrative redundancy in an electronic health record , 2010, J. Am. Medical Informatics Assoc..

[17]  Hai Fang,et al.  Projected increased growth rate of anesthesia professional-delivered sedation for colonoscopy and EGD in the United States: 2009 to 2015. , 2010, Gastrointestinal endoscopy.

[18]  A. Slivka,et al.  Quality of patient referral information for open-access endoscopic procedures. , 2006, Gastrointestinal endoscopy.

[19]  A. Jha,et al.  Electronic health record functions differ between best and worst hospitals. , 2011, The American journal of managed care.

[20]  David W. Bates,et al.  A method and knowledge base for automated inference of patient problems from structured data in an electronic medical record , 2011, J. Am. Medical Informatics Assoc..

[21]  D. Blumenthal,et al.  The "meaningful use" regulation for electronic health records. , 2010, The New England journal of medicine.