Mary L Hook

Can the Electronic Health Record Identify Vulnerable Older Adults in Need of a Palliative Care Assessment in the Hospital Setting

vides useful information that a significant portion of PN use was inappropriate in elderly adults, and the finding underlines the importance of audit and evaluation of nutritional status by a nutritional support team. Half of PN support in the present work was using Kabiven because it can be infused through a peripheral line, whereas TPN requires a central venous catheter for infusion, the use of which may carry the risk of infection in elderly adults. Therefore, Kabiven was preferred as PN support to avoid TPN-associated central line infection. In conclusion, physicians and nutritional support teams should carefully evaluate the indication for PN in elderly adults to avoid the inappropriate use of PN.

Validation and Refinement of a Pain Information Model from EHR Flowsheet Data

BACKGROUND Secondary use of electronic health record (EHR) data can reduce costs of research and quality reporting. However, EHR data must be consistent within and across organizations. Flowsheet data provide a rich source of interprofessional data and represents a high volume of documentation; however, content is not standardized. Health care organizations design and implement customized content for different care areas creating duplicative data that is noncomparable. In a prior study, 10 information models (IMs) were derived from an EHR that included 2.4 million patients. There was a need to evaluate the generalizability of the models across organizations. The pain IM was selected for evaluation and refinement because pain is a commonly occurring problem associated with high costs for pain management. OBJECTIVE The purpose of our study was to validate and further refine a pain IM from EHR flowsheet data that standardizes pain concepts, definitions, and associated value sets for assessments, goals, interventions, and outcomes. METHODS A retrospective observational study was conducted using an iterative consensus-based approach to map, analyze, and evaluate data from 10 organizations. RESULTS The aggregated metadata from the EHRs of 8 large health care organizations and the design build in 2 additional organizations represented flowsheet data from 6.6 million patients, 27 million encounters, and 683 million observations. The final pain IM has 30 concepts, 4 panels (classes), and 396 value set items. Results are built on Logical Observation Identifiers Names and Codes (LOINC) pain assessment terms and extend the need for additional terms to support interoperability. CONCLUSION The resulting pain IM is a consensus model based on actual EHR documentation in the participating health systems. The IM captures the most important concepts related to pain.

Acute Care for Elders (ACE) Tracker and e-Geriatrician Telemedicine Programs

The Acute Care for Elders (ACE) Program was developed, implemented, and results published by Dr. Seth Landefeld, Dr. Robert Palmer, and colleagues 20 years ago. This model of care has been described in an earlier chapter indicating the need to address the growing older adult patient population with increasingly complex care needs when hospitalized. This chapter describes how Aurora Health Care in Wisconsin has widely disseminated this model of care within its large system, leveraging the electronic health record (EHR) and other technology tools.

Innovative Approach to Measure Delirium in Hospitalized Older Adults Using the Electronic Health Record

To the Editor: The Acute Care for the Elderly (ACE) Tracker is an innovative clinical decision support tool generated from the electronic health record (EHR). The EHR delirium marker is derived from variables noted on the ACE Tracker: nursing documentation in the EHR, use of physical restraints, and pharmacological treatment for delirium (use of quetiapine, haloperidol, olanzapine, or risperidone). The combining of these data elements is consistent with a previous study. The EHR delirium marker was intended to be used by the healthcare team during interdisciplinary team meetings and remote consultation by the “e-Geriatrician.” The purpose of this investigation was to examine the validity of the EHR delirium marker in identifying individuals with delirium.