临床决策支持 cgu-emr-IS377-2005-10-06.pptVIP

Electronic Health Records Robert A. Jenders, MD, MS, FACP Associate Professor, Department of Medicine Cedars-Sinai Medical Center University of California, Los Angeles Co-Chair, Clinical Decision Support Technical Committee, HL7 6 October 2005 Overview: EMRs Using the EMR: Why we need it History aspects of the EMR Adoption: Barriers Improving adoption: standards, interoperability Case study: CSMC Demonstration: Centricity Need for EHR = CDSS: Medical Errors Estimated annual mortality Air travel deaths 300 AIDS 16,500 Breast cancer 43,000 Highway fatalities 43,500 Preventable medical errors 44,000 - (1 jet crash/day) 98,000 Costs of Preventable Medical Errors: $29 billion/year overall Kohn LT, Corrigan JM, Donaldson MS eds. Institute of Medicine. To Err is Human: Building a Safer Health System. Washington, DC: NAP, 1999. Need for EHR/CDSS:Evidence of Poor Performance USA: Only 54.9% of adults receive recommended care for typical conditions community-acquired pneumonia: 39% asthma: 53.5% hypertension: 64.9% McGlynn EA, Asch SM, Adams J et al. The quality of health care delivered to adults in the United States. N Engl J Med 2003;348:2635-2645. Delay in adoption: 10+ years for adoption of thrombolytic therapy Antman EM, Lau J, Kupelnick B et al. A comparison of results of meta-analyses of randomized control trials and recommendations of clinical experts. Treatments for myocardial infarction. JAMA 1992;268(2):240-8. Examples of EHR/CDSS Effectiveness Reminders of Redundant Test Ordering intervention: reminder of recent lab result result: reduction in hospital charges (13%) Tierney WM, Miller ME, Overhage JM et al. Physician inpatient order writing on microcomputer workstations. Effects on resource utilization.JAMA 1993;269(3):379-83. CPOE Implementation Population: hospitalized patients over 4 years Non-missed-dose medication error rate fell 81% Potentially injurious errors fell 86% Bates DW, Teich J