First Word: The Clinical Promise of IT

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 - C.P. Kaiser

All medical procedures and personnel performances are being scrutinized to ensure minimal waste and maximal outcomes and output. A study last month about non-evidence-based implantable cardioverter-defibrillator (ICD) procedures received a lot of press. And rightly so.

While the high rate of inappropriate implants (one-fifth) is of concern, equally troubling is the high rate of variability between hospitals—from zero to 40 percent—regarding off-guideline procedures. Closing this gap would most certainly improve care.

These data were gleaned from the American College of Cardiology’s National Cardiovascular Data Registry-ICD Registry—which demonstrates its particular value for the cardiovascular community and how IT can help improve quality of care. These are hard facts and provide a good foundation for moving forward.

Two of the largest patient cohorts that received inappropriate ICDs were those with newly diagnosed heart failure and those within 40 days of an MI. In this issue, we feature an article that tracks the use of the EMR for these two patient populations. In the most sophisticated health systems, data from pre-hospital contact to hospital engagement to home tele-monitoring are directly imported into the patient’s EMR.

These EMRs, however, have to be more than static repositories of medical data. They have to be “deployed as a dynamic patient management tool,” says Dr. Clyde Yancy. When utilized as such, inappropriate ICD implantation, among other negative metrics, could be reduced considerably.

In fact, Ochsner Health System in New Orleans uses its cardiovascular information system (CVIS) to deliver more personalized guideline-driven care to patients with acute MI or acute coronary syndromes. Consequently, it has seen a considerable reduction in mortality.

Perhaps better connectivity will ultimately result in improved cath lab oversight. For now, however, many say the peer review process is broken and want outside agencies involved. Cath lab accreditation is the wave of the future and it is only a matter of time before payors demand such action.

While the fate of the healthcare reform law is in flux with the new power structure in the U.S. House of Representatives, one certainty is the promise of EMRs and other IT systems to improve the quality of care and rein in costs. I welcome your comments and would like to know if this “promise” has become a “reality” for you.