Improving Safety and Quality with Integrated Technology

Discontinuities in clinical information systems pose a large problem for everyday clinical practices. Although care for patients spans outpatient and inpatient settings, clinical information systems, until recently, have focused on either outpatient or inpatient systems, but not both. This project aimed to demonstrate the value of an integrated outpatient and inpatient health information system to improve quality of health care and patient safety.

There are many examples of conditions that cause patients to transition across outpatient and inpatient settings, including diabetes, asthma, and congestive heart disease. Pregnancy is an ideal situation to test the hypothesis that integration makes a difference, since 4 million women annually transition across outpatient and inpatient settings. The investigators of this project chose a common and potentially life threatening condition, group B streptococcus (GBS), to demonstrate the value of an integrated data system. The specific aims of the project were to:

1. Demonstrate the value of an integrated outpatient and inpatient health information technology system to improve quality of care and safety for women and infants;
2. Demonstrate the value of an electronic alert system to increase GBS screening in the outpatient setting; and
3. Perform a policy analysis comparing the costs and implications for GBS screening according to United States, Canadian, and United Kingdom policies to inform health care delivery and obstetric safety discussions.

This project demonstrated that an integrated outpatient and inpatient data system has considerable value to improving patient safety, including an increase in documentation completeness and communication of important clinical information to other providers. The investigators also found an improvement in timely access to time-critical information, and decision support to promote safe care practices related to GBS screening and treatment. Additionally, the breadth of data allowed the investigators to perform a policy analysis comparing Canadian, U.S., and U.K. screening and management policies for GBS and the costs relating to each. Such data are very informative to the discussion surrounding the safe and cost efficient redesign of the U.S. health care delivery system.