CHAPTER 8: Principles of Medical Informatics and Clinical Informatics in the ICU

KEY POINTS

• Development of data integration platforms, Clinical Decision Support Systems (CDSS), telemedicine, and mobile computing applications are rapidly changing the acute hospital environment.

• The widespread adoption of health information technology (HIT) is being actively promoted as a tool to facilitate quality and safety of health care.

• High cost, indiscriminate data presentation, information overload, and a lack of human factor consideration present significant barriers to wider HIT adoption.

• Although HIT adoption improved some elements of quality and safety, there is currently little evidence to prove that HIT adoption is associated with improved patient-centered outcomes.

• To get the most from the digitalization of the ICU environment, an integrated and multidisciplinary approach is required. Medical informatics and human factor engineering provide a core methodology and tools for meaningful use of HIT to optimize quality and safety of critical care delivery

INTRODUCTION

It has been estimated that ICU patients are exposed to an average of 178 processes of care every 24 hours.¹ Each process is an opportunity for the system of health care delivery to fail. The same study estimated that the rate of failure, in the form of errors, which caused or had the potential to cause harm, was about 1%, or just fewer than 2 per patient per day. This may seem a small number of failures but when one considers severity of illness of ICU patients, it is not surprising that they are particularly vulnerable to those errors. With the declaration of Vienna, the elimination of error in the ICU has been determined to be the single most important priority of the critical care societies of all major developed and developing nations including the Society of Critical Care Medicine in the USA and European Society of Intensive Care Medicine. The combination of health information technology, medical informatics, and an invested team of frontline providers has the potential to play an important role in the redesign of ICU systems of health care delivery. In this chapter, we outline the application of medical informatics in the acute care setting. With examples, we illustrate some of the challenges and opportunities that exist for acute care settings equipped with a comprehensive electronic health record.

HEALTH INFORMATION TECHNOLOGY AND ELECTRONIC HEALTH RECORD

Health care providers and policy makers already support the use of health information technology (HIT) as a tool for providing efficient, high-quality patient care. HIT has been defined as “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making.” Electronic health record (EHR) is one application of HIT and is perhaps the one most familiar to bedside providers.

Widespread adoption of interoperable HIT has become a top priority for health care systems in both developed and developing nations. In the USA, implementation of ...