Technologys Vital Role in Infection Surveillance

At Hamot Medical Center, we pride ourselves for being early adopters of technology to help improve patient care. There is no exception when it comes to our infection control department. One particular technology that has proven to be very valuable for monitoring and tracking infections at Hamot is Cardinal Healths MedMined services.

Prior to MedMined, Hamot resembled the typical hospital when it came to infection control. Because it is virtually impossible to conduct manual surveillance on every admission, we focused our efforts where we thought we could provide the most value to patients. That meant spending a majority of our time looking at the heavy hitters in our patient populations and areas of the hospital that were at greatest risk to developing the most serious and costly types of hospital-acquired infections (HAIs). We would typically do targeted surveillance on surgical patients and high-risk areas, such as the intensive care unit (ICU), to ensure our most fragile patients were being monitored for HAIs.

While this certainly helped these areas and allowed us to focus, we realized we were only reaching about 10 percent to 20 percent of our patients. That left at least 80 percent of our patients unmonitored when it came to HAIs. We felt that we were unable to adequately assess the impact of our prevention efforts because we knew we were not aware of the full scope of HAIs throughout the medical center. Thats were MedMined came in.

The MedMined technology follows every patient admitted to Hamot. It analyzes our hospitals microbiology lab data, and provides a very objective view of what is and is not an HAI. With manual surveillance, a persons subjectivity can bias the data, but MedMined uses a standardized case definition of an infection and only those with lab data that supports the definition are shown as having an infection.

The technology is also powerful enough to tell us the likely source of infection as well as the unit where the patient likely acquired the infection. Combined with the lab data, the system also incorporates admission, date, time and census information so it knows where the patient was admitted and where they have moved throughout the hospital.

When we began using MedMined, we were suddenly aware that urinary tract infections (UTIs) were our largest source of infections.

When doing manual surveillance, UTIs didnt take high priority. We assumed they were relatively inexpensive to treat and we didnt appreciate the scope of the problem until we analyzed them as a whole across the medical center. This revealed the fact that collectively, they were the most costly HAI to our hospital.

With that additional piece of information and the guidelines and recommendations that MedMined provides, we were able to educate our staff on steps to prevent UTIs and demonstrate to them the impact of their efforts.

While this is just one example of the benefit that technology has played in our hospital, weve learned a great deal on what to look for in other new technologies. The following are five guidelines that we would propose when assessing technologies for your hospital. We recommend technologies that can:

1.Eliminate non-value added work so you can spend more time on the tasks that really make a difference. By eliminating the manual data collection and analysis efforts, we have been able to spend much more time on the units engaging and educating our nurses and staff. Our system gives us real-time data on infections, so we can use weekly reports to track a units success. Last year, we challenged the entire medical center to reduce the overall HAI rate by 10 percent from our baseline. The medical center staff achieved a 13 percent reduction below the set target. The results were so successful that weve set new targets for HAI reduction again this year.

2.Quantify improved patient outcomes and financial return on investment (ROI). Any technology that a hospital implements should be used to help improve outcomes and have the ability to measure the associated impact. An additional feature that is unique to the MedMined service is the financial analysis. Our patient data is tied directly with our financial systems allowing for a detailed look at our costs associated with our infections. The analysis gives us an exact picture of how much HAIs cost for our specific hospital, by looking at DRGs and comparing costs, profits and losses associated with those patients who acquire an infection with those who did not. When we have a quality improvement project, we can equate a 10 percent reduction in HAIs to the exact dollars saved for Hamot. This information better prepares infection control to talk with our hospital administrators about the return on investment MedMined has provided us, giving us a platform for additional resources for further infection reduction.

3.Give you a hospital-wide and objective view of your infections. Understanding infection rates across an entire hospital is important to maintain the safest environment for patients, but it is becoming even more financially important with the Centers for Medicare and Medicaid Services (CMS)s recent decision to stop reimbursements for certain types of HAIs. Before MedMined services, we wouldnt have known our financial exposure to this new rule, because we only looked at a small percent of our patient population. We now have the ability to calculate what percent of our Medicare and Medicaid patients are acquiring an infection, so we know exactly where we stand. The objectivity of the system is extremely important because it is an unbiased way of getting a true measure of success in reducing infection rates within your facility. The standardization lets us know our rates are computed the same way every time, so an HAI wont be counted by one ICP and not the other. To facilitate the best comparisons, you need to be comparing on the exact same set of variables. MedMined is inherently more valid and reliable than traditional surveillance.

4.Get up and running quickly. This is a consideration that you should talk to your hospitals IT staff about. Weve learned that the less invasive the technology is to your hospitals network, the more quickly you can get up and running. Our technology only required a server to be installed on our network and the intensive data mining and analysis is done off site at one of Cardinal Healths data centers, which allows for fast implementation. With the CMS decision less than a year away, you should consider beginning immediately. The implementation is not the only factor; the process of finding the right technology for your hospital and getting through the internal approval processes can be timely.

5.Provide a solid support team behind the technology. Transitioning to a new technology can be overwhelming, especially when it means learning to incorporate new concepts into your daily work. For infection control professionals, electronic surveillance is a paradigm shift from what weve done over the past 20 years, but if the technology comes with a good installation and support team, the process can be smooth. For example, the MedMined service not only has technical experts to help fix anything that could go wrong with the servers or application, they have epidemiologists and former ICPs on staff at their customer support center who act as an extension of your infection control team. They are experts on the technology and in the field of infection control. Through their exposure to the hundreds of hospitals they support, they can share best practices that have worked at other hospitals. This community of support is invaluable to getting the most out of new technology.

Emily McCracken, MPH, is director of infection control at Hamot Medical Center in Erie, Pa.