Evaluating Electronic Surveillance Systems

To access a special digital issue on electronic surveillance systems, CLICK HERE.

To access a related slide show featuring results from a survey of infection preventionists about their experiences with ESS, CLICK HERE.

 

Infection Control Today invited members of industry within the electronic surveillance system category to share their perspective on product evaluation and purchasing.

What should infection preventionists look for when evaluating an electronic surveillance system? 

CareFusion/MedMined: Infection preventionists should look for an electronic surveillance system that provides automated facility-wide identification of likely infections, streamlined regulatory reporting, demonstrated outcomes, timely implementation to enhance speed to value, and dedicated customer support. With automated case-finding tools provided by CareFusion MedMined® services, infection preventionists can be assured that data is accurate, complete and reflective of their current hospital state. MedMined frees infection control staff to focus on priority infection prevention activities, assured that mandatory reporting requirements are met. The MedMined system moves beyond reporting to equip the infection prevention team with information on emerging trends in HAIs and MDROs, helping to measurably and sustainably improve patient safety.

ICNet: Flexability and ease of integration with your legacy hospital systems are critical to minimizing IT burden and speeding implementation. Ask a vendor if it can accept data from your existing systems (including importing historic data, accepting text, spreadsheets or XML) without costly changes to the interface (and implementation delays) from your EMR, lab information system, surgery and pharmacy. Can your vendor accept and process the additional interfaces required to achieve true syndromic surveillance, including vital signs, blood chemistries, radiology, and free-text doctor notes? Finally, do you control your data? You may choose someday to migrate to a new system.

Premier: Choosing an electronic surveillance system is an extremely complex and challenging experience. When evaluating electronic surveillance systems, infection preventionists should look for a system that will require little ongoing management -- especially of IT resources -- and a vendor partner who has been supporting surveillance for more than five years that has experience with a large number of their peers. Only those vendors will be able to provide long term clinical support to help manage the ever changing requirements of reporting mandates.

rL Solutions: Electronic surveillance systems all basically do an equivalent job when it comes to surveillance.  IPs should look for a system that is easy to use and allows for configuration to their specifications.  IPs should look for a vendor they feel is the right fit for them; a vendor they are comfortable working with; one that is responsive their requests for changes and enhancements in a timely manner and is not going to charge for each minor change request and every report requested.

Sentri 7: Infection preventionists should look for the following:
1. Ability to extract and transform laboratory, medication, radiology and patient demographic data from the facility databases into readily available and comprehensible information for use by the infection preventionist.  Specifically, the automated system would provide line listings of patients with positive cultures that could be sorted by site, patient location and organism.
2. Ability to perform data analytics to help distinguish random variation of events from a cluster or outbreak situation.
3. Ability to generate electronic notifications of sentinel events established by the individual users.
4. Ability to generate antibiogram reports for use by clinicians making decisions about empiric antibiotic therapy.
5. Internet-based through a secure server that complies with the Health Insurance Portability and Accountability Act (HIPAA) to ensure patient confidentiality.
6. Marketed by a vendor that solicits user feedback and makes improvements based on that feedback to continually improve system functionality. 

TheraDoc: Infection preventionists should look for an electronic clinical surveillance system that provides them maximum control, and can offer objective evidence of success. The TheraDoc Infection Control Assistant can provide the IP with the real-time (a matter of seconds) information needed to make a valid identification of healthcare-associated infections (HAIs) according to National Healthcare Safety Network standards, but leaves final determination of HAIs to the judgment of the IP. A recent article in the American Journal of Infection Control (Stamm, et al., 2012 Oct;40(8):688-91) found clinician determination of HAIs to be superior in terms of sensitivity, positive predictive value, and rate estimation of HAIs versus the proprietary algorithm used by another vendor. In addition, TheraDoc enables organizations to integrate data from 15 different types of source systems, and empowers IPs to choose from our library of existing alerts, create their own alerts as needed, and configure their view of the data to adjust to their preferred workflow. TheraDoc can assist IPs in reducing infection rates, time-to-isolation, and time-to-confirmation of HAIs, as well as enabling faster, easier and more accurate execution of NHSN reporting. As a result of these and other factors, not one of the nearly 500 healthcare facilities that have chosen TheraDoc has ever replaced it with another electronic surveillance system (as of Dec. 1, 2012).

Truven: When evaluating an ESS, IPs should seek a solution that meets their specific needs, and has the flexibility to support quality and performance improvement efforts across the organization:
True real-time aggregation of all clinical data
Evidence-based clinical decision support (CDS) rules that power real-time alerts and work-lists updates to enable interventions to prevent infections or other adverse clinical events, and identify HAIs
A single dashboard including clinical data, alerts, work-lists, reporting and analytics, and integrated clinical-knowledge databases
A clinician-friendly rules interface not requiring IT involvement that utilizes all clinical data elements to populate accurate, actionable work-lists

VigiLanz: Three criteria should be top of mind: 
1. Is the solution real-time? 
2. Is the solution exception-based (placing higher value on systems that deliver actionable alerts while reducing noise fatigue);
3. How easy is the system to install, configure and customize? 
VigiLanz software is typically installed in 90 days. Clinicians can easily create or modify the solution within a matter of minutes without any help from hospital IT staff.  When making their evaluations, clinicians should focus on time to ROI that is, how long before you will see payback. With VigiLanz, hospitals often see payback within year-one of their investment in new ESS technology.

What is your best advice for facilities that still need to transition to an electronic system?

CareFusion/MedMined: As the responsibilities of infection preventionist continue to expand it is becoming increasingly important to have a comprehensive program to aid in the prevention of infections, as well as controlling antibiotic-resistant organisms. Mandatory reporting is an important infection preventionist function; however, it is equally important to have a comprehensive consistent view of likely HAIs across the hospital and health-system so that appropriate multi-disciplinary prevention programs can be implemented. It is also important to integrate infection prevention programs with antimicrobial stewardship efforts to minimize the development of MDRO related infections. Additionally, infection preventionists should have the ability to link their interventions to the bottom line demonstrating a measurable reduction in overall hospital costs.

ICNet: Get your IT group involved early in the decision and focus on total cost: Will the new hardware and third-party database licensing cost more than the IP software? Will the vendor guarantee compliance with NHSN electronic interfaces for all reports without additional charges? What is the real timeline for implementation (e.g., three months to get a kickoff started, six months to order hardware, six months to rewrite HL7 interfaces, then IP software installation)? Can you be live within 120 days of sending a PO? Most importantly, is your vendor there to be your partner through the entire process (training and 24/7 online and helpline support)?

Premier: The best advice Premier can offer facilities that need to transition to an electronic system is to build broad support from multiple internal stakeholders within their facility including Pharmacy, IT, Quality and Lab. Each of these stakeholders will be critical to the successful purchase and integration of an electronic surveillance system. SafetyAdvisor: Real-time infection detection and monitoring system that generates actionable alerts and detailed reports on infection clinical pharmacy and harm rates in the hospital.

rL Solutions: One of the reasons to convert to an electronic system is to achieve efficiencies. You cannot use the same workflows and processes you used on paper and expect to see improvement. Change your workflows to maximize the use of the electronic system. Think of it like switching from receiving mailed bills to electronic bills. If you are going to print the electronic bill, cut off the remittance portion, write a check, address and stamp the envelop, put it in the mail and hope it is delivered in a week, you are not gaining any efficiency.  If you view the electronic bill on line and pay it on-line, you are done. The other important issue is to leave the paper behind. There will be pain involved -- it can be short and sweet or drawn out.  If you can go electronic for one week or two weeks, and only electronic, there will be no going back to paper.  Youll wonder how you did without it.

Sentri 7: With the current trajectory for transparency of healthcare-associated infection (HAI) rates, infection preventionists are facing an increased demand for more data collection, analysis and reporting. Although surveillance is an essential part of prevention and control, all too often it consumes too much of an infection control staffs time and energy, limiting the time available for essential educational and performance improvement efforts. Automated surveillance systems have the ability to streamline the process by facilitating efficient review of relevant data and promoting rapid identification of sentinel events and detection of outbreaks. 

TheraDoc: Leveraging available resources is critical when switching to electronic surveillance. IPs with limited expertise in information technology should turn to their IT departments for help understanding terminology and setting up the system. And, dont forget to tap the expertise of your electronic clinical surveillance vendor. With more than 10 years of experience implementing at hundreds of healthcare facilities nationwide, the TheraDoc support team is in an excellent position to provide answers, guidance, and ongoing assistance. TheraDoc Clinical Specialists customize a training plan for each organization suited to their unique needs, supplemented by access to TheraDoc On-Demand, a free online learning system. Users can also take advantage of regional TheraDoc User Community events that provide training and best-practice sharing opportunities, and TheraDoc Educational Series events that enable users to learn about critical healthcare challenges directly from key opinion leaders. Lastly, in order to keep clinicians engaged, it is important to keep your team focused on the benefits of electronic surveillance and to provide mechanisms to integrate the system into your culture, such as incentives and recognition for use of the system. 

Truven: The growing focus on quality and performance means theres no better time than now to transition to an electronic surveillance system. In a time of rapid evolution of healthcare IT requirements, the right platform can not only support the needs of infection prevention, but also pharmacy, quality improvement, and clinical care efforts. Be prepared to show why the right ESS is critical to your best performance, and the reasons that other systems, including the EHR, dont optimally support your processes. Finally, be prepared to show how better enabled infection prevention processes will contribute to improved hospital performance.

VigiLanz: The time for action is now. Healthcare is changing rapidly. Reimbursement will be negatively affected without the ability to understand real-time what is happening in your system. The need to burden hospital I.T. organizations with expensive, lengthy software installation projects is no longer efficient. VigiLanz Software-as-a-Service (SaaS) ensures IT-light projects, enabling clinicians to rapidly embrace 21st century real-time clinical intelligence for better patient care and clinical productivity.  Finally, it is vital to know the difference between buying expensive software in a box from a vendor, and responsive SaaS from a partner, such as VigiLanz, dedicated to your success.