- Clinical surveillance tools are generally doing a good job of alerting providers to sudden patient downturns and delivering meaningful decision support, yet optimizing these health IT tools to produce positive results isn’t always easy.
According to a new report from KLAS, clinical surveillance tools can be a challenge to use and may be missing key functionalities, which could limit their helpfulness.
As healthcare organizations look to get further ahead of costly and potentially deadly conditions such as sepsis and respiratory failure, deploying analytics tools that offer timely, trustworthy alerts in an intuitive manner will only become more important.
Many of the popular tools on the market, including offerings from Cerner Corporation and Epic Systems, already provide much-needed support in the inpatient setting, participants in the qualitative survey asserted.
“Though still a relatively new technology, clinical surveillance products and functionality have proven to be effective tools,” KLAS observed.
“Using detection algorithms informed by patient data from EHR documentation, lab results, monitoring devices, and other sources, these tools use clinically actionable notifications to prompt intervention and prevent patient harm. This functionality has helped healthcare organizations and caregivers better deliver patient care and improve patient outcomes.”
Most users are deploying clinical surveillance tools to assist with identifying sepsis, and are satisfied with the support these systems can deliver.
Eighty-eight percent of surveyed Epic users and more than 90 percent of Cerner users believe their clinical surveillance tools are very or somewhat helpful for driving better patient outcomes.
Users of software from Bernoulli, which primarily offers ventilator surveillance, and Stanson Health also expressed high levels of satisfaction with their products’ helpfulness.
“We have cases where we really need the algorithm because it helps us pick up on clinical declines earlier,” said one Cerner user. “We have also had some experiences where a patient triggered as septic, but our clinicians didn’t think the patient really had sepsis. However, hours later, we found out that the alert was correct.”
Added a physician from another organization, “Epic’s system does prevent errors. It prompts us when patients are sicker than we thought, and it prompts us to double-check our orders to make sure they are correct. It also prevents allergy interactions by stopping us from prescribing two medications with the same mechanism of action.”
However, not all organizations have found it easy to implement and optimize their surveillance systems.
Epic users were somewhat more likely than Cerner users to say the set-up process was difficult – and Cerner users were much more likely to credit the company with helpful customer service and support.
“Operationalizing isn’t just about the solution; it is about the training, the testing, the follow-up, and the at-the-elbow support,” said one Cerner organization. “We need that support to help us because we are asking providers to do something different.”
Both Epic and Cerner users agree that surveillance alerts and reports are adequately embedded into the electronic health record, offering insights without adding unnecessary steps to the workflow.
More than 80 percent of customers from the two companies believe the surveillance products are “deeply” embedded into the EHR workflow, compared to just a third of Bernoulli users and 77 percent of Stanson Health customers.
However, Epic and Cerner users are concerned that the tools are lacking some functionalities that could improve the delivery of care and the user experience.
Epic customers were somewhat more satisfied with existing functionalities than Cerner users, yet providers using products from both companies would like to see more streamlined processes for setting up new alerts, more flexibility for customizing solutions for different areas of the organization, and better reporting features.
“One of my biggest frustrations with the alerts from [Cerner’s] St. John Sepsis Agent is that if nurses are associated with patient, they get alerts whenever they sign back in to the system; that means they might receive alerts days later,” said a participant. “They then have to figure out whether the alert was addressed, and they can be concerned because of the time difference. That isn’t a good setup for alerts.”
Despite the challenges, few organizations expressed serious doubts about the reliability or trustworthiness of clinical alerts.
More than ninety percent of Epic and Cerner customers said they “highly” or “somewhat” trust the alerts provided by their clinical surveillance systems – and encouragingly, organizations seemed relatively unaffected by alert fatigue.
“The doctors trust the accuracy of the system,” said one CMIO using Cerner. “They all know it is overly sensitive, but it is better to get notified early or too often rather than to not get notified at all. The doctors are okay with the fact that some alerts fire when a patient isn’t septic.”
Some Epic users are taking the utility of clinical surveillance systems one step further than just identifying conditions of concern.
“We have been able to build our program for personalized medicine because of the system’s alerts,” said a participating organization. “The alerts drive patients to take advantage of our genomics service so that they can see how their genes impact their health.”
Bernoulli and Stanson Health customers also believe their systems are highly trustworthy, although smaller sample sizes of participants may slightly skew the data.
All seven participating Stanson Health customers and five out of six Bernoulli users indicated high levels of trust in the system’s alerting capabilities, indicating that these companies are comfortably keeping pace with their larger competitors.
“We have done some studies in terms of alarms and alarm response, said a cardiology director using Bernoulli’s ventilator alerts.
“We have noticed that the response to Bernoulli-prompted alarms is much better. In the past, the nurses knew why the ventilators’ alarms were going off, but they thought they could get to them in a moment. Now with Bernoulli One, the nurses know that when they hear the alarm, they need to respond right away.”
Overall, clinical surveillance systems are creating a positive impact on the inpatient setting, KLAS concluded. While optimizing these tools remains a challenging part of deployment, most customers feel as if the process is worth completing.
No matter what the vendor, healthcare organizations can rely on their clinical surveillance systems to offer them meaningful, trustworthy data in a timely and actionable manner.