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Health & Medicine |
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Can computerized Alerts Help in Medical Practice?
Dr. Humberto F. Mandirola Brieux
Diego Kaminker HL7 ARGENTINA, HOSPITAL ITALIANO, HOSPITAL BELGRANO
www.hl7latam.org 1
APAMI 2014
8th Asia Pacific Association for Medical Informatics Conference
New Delhi, India
3latitud 34°33'0.54"S
longitud 58°31'32.33"O
Acute Hospital of medium level
200 Beds
8 Critical care unit beds
250 Physicians
INTRODUCTION
Focus on nutritional risk
detection.
An alert software was used.
Malnutrition often goes
unnoticed.
www.hl7latam.org 4
MALNUTRITION PREVALENCE
Malnutrition is a serious concern.
The prevalence of malnutrition
problems is higher than believed.
It’s a serious underestimated problem.
The prevalence is 30%, out of which
70% goes undiagnosed..
www.hl7latam.org 5
MALNUTRITION FACTORS
Factors which have negative impact on nutrition:
Difficulties in monitoring weight.
Patients do not like hospital food.
They may lose appetite.
The disease itself consumes energy.
Doctors may neglect the nutritional aspect. They
focus mainly on the disease and studies, and not on
nutritional aspects.
www.hl7latam.org 6
History Project
Our aim to diminish the
malnourishment rate.
Nutritional aspects assessed by
doctors.
Multidisciplinary approach.
Creation of an automatic alarm.
www.hl7tatam.org 7
CPOE
Positive effects
delay in order completion and processing
duplicate orders,
overdoses,
allergic reactions and drug interactions.
Negative effects
Alert fatigue
www.hl7latam.org 8
THE ALERT ENGINE
The alert engine in .NET and in C#.
We used different standards.
LOINC to laboratory data
ICD10 to medical record data.
HL7 2.4 to transfer data.
www.hl7latam.org 9
www.hl7latam.org 10
Ale
rt
gro
up
Co
ntr
ol
gro
up
Bo
th
gro
up
s
Total 200 200 400
Age max 96 90 96
Age min 34 22 22
Age average 65,25 56,00 60,63
SAMPLES
www.hl7latam.org 12
HOW THE ALERT ENGINE WORKS
LIS EMR
CLINCIAL ALTERT ENGINE
HL7 INTERFACE
www.hl7latam.org 13
Alert Control
Total 198 197
Undetected nutritional risk 130 157
Detected nutritional risk 68 40
(p<0.001) 34,3 % 20,3 %
RESULTS
CONCLUSION
The nutritional risk alert we built was of
significant help.
Detection of malnutrition in patients
increased by 14%.
It is very important to use alerts.
Physicians using alerts could diagnose
more problems.
1. .
www.hl7latam.org 14
DISCUSION
It is important to avoid
overabundance of alerts.
Early detection of malnutrition
plays a fundamental role in
reducing morbidity in patients.
www.hl7latm.org 15
