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Clinical information systems: An opportunity to measure value, investigate and innovate from the real world
Los sistemas de información clínica: una oportunidad para medir valor, investigar e innovar a partir del mundo real
a Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII; Instituto de Investigación Sanitaria Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain
b Centro de Críticos, Hospital Universitario Parc Taulí, Institut de Investigació i Innovació Parc Taulí, I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain
c Oficina de Innovación, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
d Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III Majadahonda, Madrid, Spain
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Incluye: mapa del servicio (permite conocer gráficamente las técnicas de soporte vital en los pacientes ingresados el día de la consulta, las cargas de trabajo para el profesional médico y de enfermería); conjunto mínimo de base de datos de medicina intensiva (CMBD-UCI); consumo y gasto en productos farmacéuticos; indicadores de calidad. Además, permite consultas <span class="elsevierStyleItalic">ad-hoc</span>, con objetivos de mejora continua de la calidad asistencial y de gestión.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">LOPD: ley orgánica de protección de datos; MI: medicina intensiva; SIC: sistemas de información clínica; SNS: Sistema Nacional de Salud; TI: tecnología de la información; UCI: unidad de cuidados intensivos.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "M. Bodí, Ll. Blanch, R. Maspons" "autores" => array:3 [ 0 => array:2 [ "nombre" => "M." "apellidos" => "Bodí" ] 1 => array:2 [ "nombre" => "Ll." 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"apellidos" => "Maspons" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Intensiva, Hospital Universitario de Tarragona Joan XXIII; Instituto de Investigación Sanitaria Pere Virgili, Universitat Rovira i Virgili, Tarragona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Centro de Críticos, Hospital Universitario Parc Taulí, Institut de Investigació i Innovació Parc Taulí, I3PT, Universitat Autònoma de Barcelona, Sabadell, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Oficina de Innovación, Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III Majadahonda, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Los sistemas de información clínica: una oportunidad para medir valor, investigar e innovar a partir del mundo real" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1362 "Ancho" => 1818 "Tamanyo" => 437342 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Data extraction from the CIS, with processing and analysis using a Business Discovery application, allows the development of an operative, automated and quasi-real time management tool (Intellectual Property: i_DEPOT No. 102487). The tool includes: service map (making it possible to graphically know the life support techniques in patients admitted on the day of consultation, and the work loads for the medical and nursing professionals); minimum Intensive Care database set (MICD-ICU); drug product consumption and expenditure; and quality indicators. In addition, it allows <span class="elsevierStyleItalic">ad hoc</span> consultations, with ongoing improvement objectives referred to care quality and management. LOPD: Data Protection Act; ICM: Intensive Care Medicine; CIS: clinical information systems; SNS: Spanish National Health system; IT: information technology; ICU: Intensive Care Unit.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A press release in 2015 from one of the most important newspapers in the world, the Wall Street Journal,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">1</span></a> commented on the Risky States project of the Beth Israel Deaconess Medical Center in Boston, which allowed real-time risk estimation in an Intensive Care Unit (ICU), and on the Project Emerge of Johns Hopkins Medicine in Baltimore, which evaluates the use of complication preventive measures. The press release, addressed to society–our patients–acknowledged a change in paradigm in Medicine, with data being consolidated as the backbone of medical care and research. Specifically, the data contained in the patient case history are a formidable source of information not only for summarizing what has happened but also for identifying patients at risk (even outside the walls of the ICU) and modulating the future: helping professionals to make decisions, and contributing to focus accumulated knowledge, experience and all our talent on the care of our patients. In effect, as underscored by recent articles published in <span class="elsevierStyleSmallCaps">Medicina Intensiva</span>.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">2–4</span></a> and in JAMA,<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">5,6</span></a> the physician attending the patient and who possesses the knowledge and quality and cost information (through specific tools) is the individual that will exert an influence upon the necessary transition from a healthcare model based on volume to a model based on value. Only in this way can we guarantee efficient, highly qualified and patient-centered work with improved outcomes.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Information technology clearly offers an excellent opportunity for improving medical care. Our Society, through the five High Interest Recommendations,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">7</span></a> points to Clinical Information Systems (CIS) as a tool for incrementing quality and safety. The SEMICYUC likewise has established definitions of the technical and functional standards of the CIS.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In addition to affording a database, information technology, through the CIS, makes it possible to measure what we do, analyze process adherence to scientific evidence, improve professional performance, and evaluate the impact of improvement strategies. In this regard, following a SWOT (Strengths, Weaknesses, Opportunities and Threats) strategic analysis, our group has developed a platform allowing the inclusion, calculation (based on defined metrics) and analysis of the data automatically derived from the CIS (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). It would not be possible to obtain this information through manual data entry by the Intensive Care professionals.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Indicators,<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">9</span></a> as the best tools for measuring quality, are strongly conditioned by the time required and the complexity involved in collecting the information needed to calculate them. Effort should be guided in search of indicators that are measurable, reliable and precise (reproducible), drawn from the data contained in the CIS.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">10</span></a> This would favor the homogenization of definitions and reduce time consumption on the part of the professionals. However, automatic calculation, seeking objectiveness, is not possible without their contribution, since medical criterion is sometimes needed in order to assess consistency with concrete definitions. This point has generated debate for example in calculating events related to mechanical ventilation.<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">11</span></a> In any case, redefinition of an important group of indicators is probably required, establishing definitions that are consensus-based, precise and adapted to the information contained in the CIS, where possible–avoiding the duplication of efforts and the development of parallel software applications. Prior evidence has been obtained of the accuracy and correlation of the results referred to manually and automatically analyzed indicators.<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">12</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The information of the CIS will also allow a new approach to critical patient safety. Up until now, we were able to face foreseeable events by using checklists, for example.<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">13</span></a> However, analysis of the variables contained in the CIS could offer an approach to predictive models and identify associations between variables that previously would have gone unnoticed. Based on new forms of analysis, we are able not only to avoid errors but also to monitor them and analyze their predisposing factors–including even data from other sources (position sensors referred to patients and professionals, for example).</p><p id="par0030" class="elsevierStylePara elsevierViewall">We assume that the intensivist must define the objectives, and that technical execution is the work of software engineers–this resulting in new relationships within our specialty.<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">14</span></a> We must be ready for other novelties such as for example the availability of professionals trained in managing the new information generated. Ghassemi speaks of a new Learning Healthcare System.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">15</span></a> Although traditional clinical research has been based on randomized clinical studies, there are numerous and varied databases, ranging from case histories to registries, benchmarking platforms and administrative data, among others.<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">16</span></a> It all depends on the question we ask. What until now was years of data input, with important effort on the part of the clinician, can now be replaced or complemented by the data of the CIS. However, this great body of information cannot be addressed by means of the usual statistical models, and obliges us to speak of big data and predictive models.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Important advances have clearly been made in data acquisition, integration and storage capacity, though we also must incorporate other developments in information technology, biomedical engineering, signal processing (curves, images) and algorithms for the diagnosis of events, that can only be compiled on a computerized basis.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">17</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In order to prevent things from becoming mere isolated events or anecdotes in the newspapers, critical care professionals must participate in the configuration of the CIS, in accordance with the care processes, with commitment to the checking of safety and quality data, and investigation of their true usefulness, reliability and correlation to the classical sources. All this will require adequate management of the change, overcoming resistances among professionals, and addressing the ethical and legal issues jointly with the administration–such steps already having been taken by the <span class="elsevierStyleItalic">AQuAS</span> in Catalonia, for example.<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">18</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">MB and RM state that they have no conflicts of interest. LB is the inventor of a United States patent held by the <span class="elsevierStyleItalic">Corporació Sanitaria Parc Taulí</span>, Spain: “Method and system for managing related patient parameters provided by a monitoring device”, US Patent No. 12/538,940. LB holds shares in BetterCare S.L., a start-up of the <span class="elsevierStyleItalic">Corporació Sanitària Parc Taulí</span>, Spain.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-10-17" "fechaAceptado" => "2016-10-26" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Bodí M, Blanch Ll, Maspons R. Los sistemas de información clínica: una oportunidad para medir valor, investigar e innovar a partir del mundo real. Med Intensiva. 2017;41:316–318.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1362 "Ancho" => 1818 "Tamanyo" => 437342 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Data extraction from the CIS, with processing and analysis using a Business Discovery application, allows the development of an operative, automated and quasi-real time management tool (Intellectual Property: i_DEPOT No. 102487). The tool includes: service map (making it possible to graphically know the life support techniques in patients admitted on the day of consultation, and the work loads for the medical and nursing professionals); minimum Intensive Care database set (MICD-ICU); drug product consumption and expenditure; and quality indicators. In addition, it allows <span class="elsevierStyleItalic">ad hoc</span> consultations, with ongoing improvement objectives referred to care quality and management. LOPD: Data Protection Act; ICM: Intensive Care Medicine; CIS: clinical information systems; SNS: Spanish National Health system; IT: information technology; ICU: Intensive Care Unit.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:18 [ 0 => array:3 [ "identificador" => "bib0095" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Hospital ICUs Mine Big Data in Push for Better Outcomes. Researchers look for clues in the wealth of information from past cases. Laura Landro. Wall Street Journal Updated June 25, 2015. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 3 | 8 |
| 2024 October | 67 | 50 | 117 |
| 2024 September | 61 | 47 | 108 |
| 2024 August | 76 | 53 | 129 |
| 2024 July | 52 | 33 | 85 |
| 2024 June | 64 | 44 | 108 |
| 2024 May | 45 | 34 | 79 |
| 2024 April | 54 | 39 | 93 |
| 2024 March | 71 | 27 | 98 |
| 2024 February | 69 | 36 | 105 |
| 2024 January | 78 | 38 | 116 |
| 2023 December | 53 | 31 | 84 |
| 2023 November | 65 | 38 | 103 |
| 2023 October | 64 | 44 | 108 |
| 2023 September | 38 | 51 | 89 |
| 2023 August | 56 | 19 | 75 |
| 2023 July | 46 | 33 | 79 |
| 2023 June | 55 | 21 | 76 |
| 2023 May | 114 | 33 | 147 |
| 2023 April | 64 | 28 | 92 |
| 2023 March | 103 | 42 | 145 |
| 2023 February | 112 | 30 | 142 |
| 2023 January | 80 | 39 | 119 |
| 2022 December | 130 | 54 | 184 |
| 2022 November | 129 | 53 | 182 |
| 2022 October | 171 | 56 | 227 |
| 2022 September | 137 | 48 | 185 |
| 2022 August | 110 | 46 | 156 |
| 2022 July | 107 | 50 | 157 |
| 2022 June | 135 | 35 | 170 |
| 2022 May | 111 | 38 | 149 |
| 2022 April | 121 | 45 | 166 |
| 2022 March | 153 | 70 | 223 |
| 2022 February | 134 | 48 | 182 |
| 2022 January | 116 | 41 | 157 |
| 2021 December | 140 | 61 | 201 |
| 2021 November | 101 | 51 | 152 |
| 2021 October | 139 | 78 | 217 |
| 2021 September | 98 | 36 | 134 |
| 2021 August | 72 | 45 | 117 |
| 2021 July | 99 | 42 | 141 |
| 2021 June | 166 | 29 | 195 |
| 2021 May | 148 | 61 | 209 |
| 2021 April | 375 | 88 | 463 |
| 2021 March | 258 | 45 | 303 |
| 2021 February | 137 | 27 | 164 |
| 2021 January | 130 | 36 | 166 |
| 2020 December | 107 | 25 | 132 |
| 2020 November | 111 | 31 | 142 |
| 2020 October | 93 | 38 | 131 |
| 2020 September | 93 | 19 | 112 |
| 2020 August | 87 | 19 | 106 |
| 2020 July | 128 | 35 | 163 |
| 2020 June | 120 | 20 | 140 |
| 2020 May | 151 | 14 | 165 |
| 2020 April | 103 | 29 | 132 |
| 2020 March | 103 | 30 | 133 |
| 2020 February | 294 | 39 | 333 |
| 2020 January | 198 | 30 | 228 |
| 2019 December | 149 | 21 | 170 |
| 2019 November | 221 | 46 | 267 |
| 2019 October | 405 | 47 | 452 |
| 2019 September | 220 | 29 | 249 |
| 2019 August | 156 | 28 | 184 |
| 2019 July | 138 | 29 | 167 |
| 2019 June | 118 | 21 | 139 |
| 2019 May | 128 | 37 | 165 |
| 2019 April | 108 | 19 | 127 |
| 2019 March | 162 | 28 | 190 |
| 2019 February | 123 | 30 | 153 |
| 2019 January | 160 | 34 | 194 |
| 2018 December | 137 | 30 | 167 |
| 2018 November | 155 | 93 | 248 |
| 2018 October | 78 | 21 | 99 |
| 2018 September | 45 | 10 | 55 |
| 2018 August | 26 | 8 | 34 |
| 2018 July | 31 | 17 | 48 |
| 2018 June | 37 | 13 | 50 |
| 2018 May | 17 | 11 | 28 |
| 2018 April | 51 | 19 | 70 |
| 2018 March | 27 | 8 | 35 |
| 2018 February | 31 | 12 | 43 |
| 2018 January | 43 | 26 | 69 |
| 2017 December | 28 | 15 | 43 |
| 2017 November | 51 | 22 | 73 |
| 2017 October | 44 | 0 | 44 |
| 2017 September | 3 | 0 | 3 |
| 2017 August | 0 | 1 | 1 |
| 2017 July | 2 | 2 | 4 |
| 2017 May | 0 | 1 | 1 |
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