The National Institute for Medical Informatics has designed, built and deployed an award-winning, real-time clinical information system called Azyxxi (rhymes with Trixie) that now has 500 terabytes of installed drive capacity and provides access to more than 11,000 clinical data elements in just one-eighth of a second. The system maintains all clinical information for all inpatients and outpatients across seven hospitals, including Washington Hospital Center, the flagship of not-for-profit MedStar Health Group, and the largest hospital in the nation's capital.
The system was originally built to address the common problem of unmet clinical needs in a high-intensity practice environment. Available commercial systems didn't fit the bill: Not only were they too rigid, with a tendency to lock an institution into yesterday's business and practice models, but they also provided a purely single-patient-oriented view that failed to adequately support many tasks that must be performed routinely within a hospital setting. We set out to create something that would complete specific tasks within a set time period.
When dealing with a single patient, in less than a quarter of a second, the system had to:
- Show current and prior lab results.
- Show X-ray images and readings.
- Show cardiac angiograms (video).
- Show scanned versions of old paper charts.
- Show a list of medications administered.
- Show the date of the patient's most recent visit to our facility.
- Show all diagnoses and procedures in the medical history.
- Determine how many patients are presently in each department.
- List which patients have not yet been fully registered.
- Show all inpatients who had a fever and respiratory symptoms.
- Show all the elevated glucose results for all patients.
- Show all chest-pain patients who did not receive aspirin within the first hour.
- Show which hospital rooms have been associated with more than two cases of drug-resistant nosocomial infection.
- Show all cases for which payment was denied and that have not yet been appealed.
All data are kept live, including all X-rays, angiograms and images. Powerful tools permit new data sources to be interfaced in a matter of hours, and new user functions and screens can be added in hours or days.
The main screen is a grid with a row of information for each member of a cohort of patients. The default setting is all the patients in a specific hospital wing, but with a single click the user can easily choose to see just his or her patients, or all patients for any range of dates who meet any arbitrary filtering criteria based on any existing information field. For example, in less than a second, we can list all patients seen in the last two weeks who were complaining of chest pain or all patients seen by a particular doctor within the past three months.
For each patient, the grid row contains many different information elements. The list of elements for a patient can be customized on the fly to include any of 11,000 different fields of information. Any entry can be expanded by clicking on a grid cell to get more information. For example, a grid cell showing the time of the most recent lab results can be clicked to see the actual lab results and a trending graph. It takes less than one second to see a pulmonary function test or a list of prior diagnoses.
The system includes a variety of special-purpose equipment, including fingerprint sensors, iris scanners, and gesture recognition and voice interaction systems. Exotic data elements include automatically acquired vital signs as well as automatic location tracking using ultra-wideband active radio-frequency identification tags. Clinicians can review data using a wireless laptop, tablet PC or PDA while strolling the hallways or making a house-call in the community-wirelessly browsing through real-time lab results, dictations, prior diagnoses, medications and even X-ray images.
The system has had a tremendous impact on the quality and efficiency of practice, and has been "pulled through" each hospital rather than pushed into use from the top down. Azyxxi has been designated for medical disaster management by the District of Columbia Department of Health and recently was used by both Maryland and Virginia for tracking regional evacuees from Hurricane Katrina. It is installed in the Command Center at HHS. It serves as headquarters for the National Capital Area Regional Health Information Organization and for a national health information exchange (HIX-One) involving care providers across Maryland, Virginia, the District of Columbia, Wisconsin, Arizona, and Santa Barbara, Calif. It has been featured in broadcast media and has been the subject of a Microsoft case study as well as four case studies at the Harvard Business School.
Not bad for a clinical data system originally intended for a small group of harried clinicians in a single department at one hospital.
Story originally published in the Nov. 14, 2005, issue of Modern Healthcare.