Hospital Implements Innovative Infection Control Through Integrated Data Solution

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1 Hospital Implements Innovative Infection Control Through Integrated Data Solution Overview Country or Region: United States Industry: Healthcare Customer Profile A member of MedStar Health, Washington Hospital Center is renowned for its work in cardiac care, cancer, neurosciences, gastrointestinal disorders, endocrinology, women's services, transplantation, and burn care. Business Situation The Infection Control department at Washington Hospital Center used multiple, non-integrated systems to access the necessary data for timely infection isolation, easy device tracking, and efficient reporting to authorities. Solution The department deployed a solution based on Microsoft Amalga that integrates vital clinical data from multiple systems and delivers it through a highly customizable role-based user interface. Benefits Minimized infection exposure Fewer costly patient transfers Comprehensive device tracking Up to 3 days faster reporting Up to 3 hours saved weekly in MRSA compliance reporting It s the kind of solution that every healthcare system would like to have. Nancy Donegan, R.N., M.P.H., Director of Infection Control, Washington Hospital Center Washington Hospital Center, the largest private hospital in the nation s capital, faced the common challenge of controlling hospital-acquired infections. Infection Control practitioners relied on multiple databases and disparate systems to accurately track where infected patients had been in the hospital. This required multiple cross checks with other departments for minimizing infection exposure among other patients and many hours spent creating required governmental reports. By implementing Microsoft Amalga Unified Intelligence System, the Infection Control department anticipates being able to quickly access comprehensive patient data, rapidly isolate infected patients, more accurately track invasive devices, and streamline healthdepartment reporting. The result: potentially reduced patient exposure, saved time for clinicians, and faster reporting to authorities.

2 Amalga will uniquely provide a system to allow analysis of device usage and isolation appropriateness. Nancy Donegan, R.N., M.P.H., Director of Infection Control, Washington Hospital Center Figure 1. Microsoft Amalga provides clinicians with a realtime view of patients that have indwelling devices with device tracker. Situation With over 900 beds and a staff of more than 6,000, Washington Hospital Center is the largest private hospital in Washington, D.C. Founded in 1958, the hospital offers extended services in primary, secondary, and tertiary care and in 2007 served more than 46,000 inpatients and 371,000 outpatients. As in all large healthcare environments, clinicians at Washington Hospital Center must maintain a tireless vigilance against the threat of infection and alert governmental authorities of infections that include hepatitis, HIV, tuberculosis, and methicillinresistant staphylococcus aureus (MRSA), a bacterial infection. Clinicians as Both Firefighters and Detectives According to Nancy Donegan, R.N., M.P.H., containing of infection requires constant oversight and rapid response. Medical professionals need the tools to succeed, she says. We use effective medications and practices to prevent or treat infections. We also use tools to track where affected patients might have acquired the infection, which other patients might have been exposed, and how to minimize or eliminate further exposure. Donegan notes that the medications and practices for preventing and fighting such infections are plentiful and powerful, as are the mechanisms for tracking them. But considering the challenge, those tracking mechanisms can always be made even more powerful. The most common scenario was a patient who became infected during his or her hospital stay, was discharged, and then was later readmitted, Donegan explains. The patient s file would indicate that he or she should be placed in an isolation room, but the indicator would not immediately show up in the admissions process. Instead, it would be available on a printed report that would be reviewed only after the patient might have been placed in a shared room, even for a few minutes. To determine how a patient already in the hospital might have acquired an infection, Donegan had to research multiple information systems. With the Amalga system, it is easy to review information from the microbiology laboratory, radiology, the emergency department, and the patient s room change record during his stay. Successful Device Tracking Imperative Clinicians must track the use of invasive devices, such as intravenous lines and urinary catheters, which on their own can increase a patient s risk of infection by breeching natural defenses. The added infection risk of invasive devices makes it imperative that the clinicians in Infection Control track their insertion, maintenance, and removal very closely, Donegan says.

3 Amalga has the potential to give laboratory personnel easy access to all the information they need on a patient who is showing positive for one of the reportable infections. Nancy Donegan, R.N., M.P.H., Director of Infection Control, Washington Hospital Center Figure 2: Since Amalga is datacentric as well as patientcentric, Amalga can sort on all patients with positive blood cultures. This type of automated daily report makes it much easier for Infection Control specialists to follow up on patients who have abnormal cultures. Donegan s department is also responsible for meeting requirements for timely, comprehensive infection reporting mandated by county, state, and federal agencies. It was a lot of work for laboratory staffers to access patient contact information, which is a required part of the reporting, she explains. When lab technicians identified a reportable infection, they had to contact Infection Control to look up the information before they could fax a report to the health department. This extra step meant more work for staff in the lab and in our department, and added at least a day s delay between recognition of an infection and delivery of the report. Solution Donegan and her colleagues considered various solutions after deciding to implement a better method for infection isolation and device tracking. Initially, Donegan s team wanted a solution that was focused on mining essential infection control data. So they considered data-mining solutions from Theradoc, MediMine, and other systems before going on to implement one from Cereplex (now Premier). But they still needed more data aggregation than was available in the data-mining solution. So in 2005, Donegan and her colleagues began making further use of Microsoft Amalga Unified Intelligence System, which was originally introduced to the department in 1999 and acquired by Microsoft in Above all, Donegan and her team wanted to take advantage of the ability of Amalga information systems and deliver it through role-based user interfaces. As Amalga evolved, Donegan found that it could provide a powerful interface between the data-mining solution, the department s microbiology database, and the hospital s mainframebased ADT (admission, discharge, transfer) system. The key to supporting our goals of infection isolation and device tracking will be the ability to access an aggregate microbiology/adt data set through a highly customizable user interface, Donegan points out. Even though we continue to perform most of the data aggregation through the data-mining solution, Amalga will uniquely provide a system to allow analysis of device usage and isolation appropriateness. Additionally, Amalga has allowed a more refined review of individual cases than the microbiology data mining systems can. During this time, Donegan and her colleagues set up group views in Amalga at the full hospital level something they couldn t do before implementing Amalga. Through an isolation-indicator field that can be queried directly, users will be able to track current isolations based on time of visit or medical record number. In the future, users will be

4 The solution will help us address those rare cases where a patient might already have been placed in a shared room, and thereby eliminate the need to move that patient into another room, Donegan says. When the patient is fragile, the move itself can pose problems, and in every case it is costly and time-consuming. Figure 3: Amalga can be used to review microorganisms by patient room, facilitating isolation. able to filter all patients on the status of the isolation indicator, and assure best patient placement, especially for patients with MRSA and other epidemiologically important Benefits Donegan and her staff believe that Microsoft Amalga Unified Intelligence System will become a huge advantage in day-to-day Infection Control at Washington Hospital Center. They anticipate that necessary patient isolation will be implemented within minutes, infection and device tracking will become more efficient, and reporting will be made faster and easier. Infection Isolation When It Matters Most According to Donegan, using Amalga has the potential to make an enormous difference in the way her department is able to track patients with infections and, most important, isolate them from other patients as quickly as possible. When Infection Control clinicians need to identify the origins of an infection, they can access a wealth of information in Amalga. In the case of a hypothetical infant with MRSA or other organism, we can also access the name and relevant medical information on the child s mother instantly, Donegan says. With this unified view linking the records of mothers and infants, we can easily verify for the public health department that we have given appropriate immune globulin and vaccine for babies whose mothers may have hepatitis or other vaccine-preventable diseases. Similarly, the clinicians can track a patient s bed assignments during his or her entire hospital stay. Amalga clearly displays where the patient has been throughout their stay and what tests or procedures they ve had done, so similarities between patients could easily be recognized, Donegan adds. Invaluable Device Tracking Although the solution is still early in development, dedicated IV care teams are using it to view a list of patients with invasive devices. With the Amalga solution, Donegan and her colleagues see the potential for something that they have wanted for many years: a device-tracking solution that will meet the needs of clinicians and others not only in Infection Control but throughout the hospital. Donegan anticipates that users of the Amalga solution will be able to see the device s insertion location, method of insertion, any

5 complications, and the history of that or other devices used with a given patient. All these factors are relevant when you are trying to determine if an infection originated with the insertion or maintenance of a device, Donegan says. They also are valuable clues if you are trying to determine whether a device of a given type, or method of insertion, is associated with a higher infection rate than others. An added advantage of the device-tracking solution is that clinicians could use it as a reminder service helping them to maintain devices in an optimum manner. Besides providing clinicians timely and comprehensive device data, the solution will also inform them when a given dressing should be changed, and so on, Donegan explains. It s the kind of solution that every healthcare system would like to have. Easier Compliance with Health- Department Reporting Donegan and her colleagues are using Microsoft Amalga Unified Intelligence Solution to give Infection Control clinicians a unified view of data that is integrated from systems throughout the hospital, which should make it easier to meet governmental reporting requirements. according to Donegan. Without Amalga, compliance would have taken Infection Control clinicians six hours each week, but with Amalga, we will be able to do this in about half that time. An Effective Tool for Reducing Future Risks For infection control data analysis, Donegan anticipates that the Amalga solution will be a significant improvement over the technologies that she and her colleagues had to rely on in the past. Amalga has the potential to be equally powerful on the back end, with comprehensive support for aggregating data from systems in microbiology, ADT, pharmacy, radiology, and others throughout the hospital, and on the front end, with easy-to-use tools for setting up sophisticated queries with evermore specific filtering, Donegan says. When we have fully implemented these tools, we ll be able to use the solution for identifying patterns and correlations, the centerpiece of effective infection control. Amalga has the potential to give laboratory personnel easy access to all the information they need on a patient who is showing positive for one of the reportable infections, Donegan says, which will, hopefully, save significant time. They should be able to get the report to the health department a full day faster and up to three days faster near a holiday. Health departments have begun recommending more frequent reporting information of MRSA which could become a significant challenge without Amalga,

6 For More Information For more information about Microsoft products and services, call the Microsoft Sales Information Center at (800) In Canada, call the Microsoft Canada Information Centre at (877) Customers who are deaf or hard-ofhearing can reach Microsoft text telephone (TTY/TDD) services at (800) in the United States or (905) in Canada. Outside the 50 United States and Canada, please contact your local Microsoft subsidiary. To access information using the World Wide Web, go to: For more information about Washington Hospital Center - Medstar products and services, call (202) or visit the Web site at: Amalga Unified Intelligence System Microsoft Amalga Unified Intelligence System (UIS) gets all your data, in one place, in real time. Amalga delivers a paradigm shift in how organizations can use the data housed in existing systems to drive change, discovery and innovation. Amalga UIS allows agile use of information because it (1) captures all data in one place in real-time, including scans, images, device data and any other type of electronic data (2) advances discoverability because it allows each end-user to ask questions today that were not thought about yesterday - without the intervention of IT, and (3) provides a different approach to interfacing and integrating from disparate data sources that reduces complexity and accelerates time to value. Amalga UIS has been adopted by industry leading organizations. As of October 2008, the list includes: Medstar (July 2006), New York Presbyterian Hospital (March 2007), Johns Hopkins (April 2007), Wisconsin Health Information Exchange (August 2007), Novant (August 2007), Moffitt (September 2007), St. Joseph Health System (November 2007), DC RHIO (June 2008), El Camino (September 2008), University of Washington (September 2008), Seattle's Children Hospital (September 2008). About Us Our vision: to improve health around the world through software innovation. Microsoft is committed to improving health around the world through software innovation. Over the past twelve years Microsoft has steadily increased its investments in health, with a focus on addressing the challenges of health providers, health and social services organizations, payers, consumers and life sciences companies, worldwide. Microsoft closely collaborates with a broad ecosystem of partners and develops its own powerful health solutions, such as Amalga and HealthVault. Together, Microsoft and its industry partners are working to advance a vision of unifying health information and making it more readily available, ensuring the best quality of life and affordable care for everyone. For more information about Amalga and other Microsoft solutions for the healthcare industry, go to: This case study is for informational purposes only. MICROSOFT MAKES NO WARRANTIES, EXPRESS OR IMPLIED, IN THIS SUMMARY. Document published March Part No Software and Services Microsoft Amalga Microsoft Server Products Portfolio Microsoft SQL Server 2005 Windows Server 2003 Standard Edition Technologies Microsoft.NET Framework