Venous Thromboembolism Risk Assessment: The Socio-Technical Impact of an Electronic Health Record and Clinical Decision Support Approach in an In-Patient Setting

Authors: David Salako

Primary Advisor: Anwar Mohammed Sirajuddin, MBBS, MS, (co-author)

Committee Members: Dean F. Sittig, PhD (co-author); Chiehwen E. Hsu, PhD; (co-author); Jiajie Zhang, PhD (co-author)

Masters thesis, The University of Texas School of Health Information Sciences at Houston.

Abstract:

Electronic health records along with their clinical decision support and computerized physician order entry capabilities can help health care professionals to reduce the prevalence of hospital acquired venous thromboembolism. In this paper we discuss the data acquired from the implementation of a venous thromboembolism risk assessment module at two inpatient hospitals within the Memorial HermannHealth Care System in Houston, TX and offer potential directions for program improvements. Data tracked for 17 months following the September 2008 implementation reveals that while the tool is being used, the adoption rate is not at the level recommended by evidence based guidelines and studies. There is also a consistently noticeable difference in the frequency of use of the venous thromboembolism risk assessment module between the two locations, even accounting for patient volume and number of in-patient bed differences. The results suggest that more concentrated Quality Improvement initiatives should be pursued. We proposed additional studies regarding the number of patients being discharged with actual hospital acquired venous thromboembolism treatment as well as the cultural similarities and differences between both locales and their relationships with centralized application development and support.