Ever since NorthShore University HealthSystem, Evanston, Ill., went live with an enterprise-wide electronic health record in 2003, clinicians and IT staff have been looking for ways to exploit the new data source to ease workflow and improve patient care. For Dr. Ari Robicsek, an epidemiologist and associate chief medical information officer for the two-hospital system, the target was antibiotic overuse.
Robicsek and his informatics colleagues have used the data collected in the health system's EHR to spearhead several programs aimed at improving antimicrobial stewardship, including a newly launched project focused on postoperative fever.
Some temperature elevation following surgery is expected, Robicsek says. But until recently, physicians had little to no idea just how much temperature elevation was normal and how much indicated a fever and possible infection.
To clear up that confusion and reduce excessive use of antibiotics, Robicsek and his team created the Wunderlich Project, named for a 19th-century German physician who conducted pioneering research on human body temperatures. They used NorthShore's EHR to identify every patient—15,000 in total—who had undergone any one of about 20 surgical procedures. Then they analyzed half a million temperature readings taken from those patients.
“What we found is that different types of procedures had very different postoperative temperature ranges,” Robicsek says.
Normal postoperative temperature ranges also varied widely based on patient characteristics such as age and gender. In other words, one temperature could indicate a fever in a particular patient who had undergone a particular procedure, such as knee replacement, but that same temperature reading could fall well within the normal range for another patient.
“There is no one magic number,” Robicsek says.
Together with the IT department, Robicsek designed a website that asks physicians what type of surgery was performed, the number of postoperative days and a few other procedure-specific and demographic questions. The system then produces a graph with a range of normal temperatures for that patient.
The model's accuracy continually improves, he adds, because new patient data is added each day.
In its first version, the system is a stand-alone website, meaning physicians must click away from the EHR to get to it. But the next version will be built into the record and eventually, Robicsek says, the data will automatically populate and the system will provide a personalized range of temperatures, reducing guesswork and facilitating appropriate antibiotic use.
Robicsek also is involved in several other projects that use EHR data to guide antibiotic administration. A project titled “What's Going Around?” provides point-of-care data to physicians about illnesses that are currently prevalent in their region. The hope, Robicsek says, is that when physicians become aware that particular viral illnesses are “going around” in their area, they will be less inclined to prescribe unnecessary antibiotics. And the results so far have shown that to be true, he says.
“We found that when physicians were highly aware that the flu was going around, they did the right thing and did not prescribe antibiotics,” Robicsek says.