October 22, 1999

WizOrder used to prompt treatment of “blood clot” cases

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Country music star Mark Collie and former Miss America Nicole Johnson will be at VUMC to raise awareness of diabetes.

WizOrder used to prompt treatment of “blood clot” cases

The Vanderbilt Medical Group Care Improvement Committee has developed a strategy to improve management of suspected and confirmed cases of deep vein thrombosis (DVT) and pulmonary embolism, together known also as “blood clot.” Pulmonary embolism is a leading cause of death among hospitalized patients.

The strategy exploits various capabilities of the WizOrder system, used throughout the hospital and clinic to order all patient tests, procedures, drugs, nursing assessments, therapy and so on. When it receives certain orders associated with thromboembolic disease, Wiz will prompt users to identify cases, thus continuously maintaining a specialized automated patient registry. Wiz will proceed to prompt and educate users regarding treatment options for these patients.

In formulating treatment guidelines, the committee sought expert advice from VMG members, settling ultimately on guidelines from the American College of Chest Physicians (as published in the November 1998 issue of Chest). Dr. Lonnie Burnett, professor of obstetrics and gynecology and chair of the committee, stressed that the guidelines are not mandatory.

“The Wiz strategy is designed to be educational and interventional, not compulsory.” Burnett continues to meet with clinical chiefs and other VMG members to explain the strategy and address any concerns. The DVT strategy is scheduled to go on line on WizOrder by the end of October.

“One of the guidelines I would stress is that, when using continuous intravenous heparin, we’re asking for optimum anti-coagulation with an aPTT of 65 to 110 seconds within 24 hours,” Burnett said. “This particular goal is now met in about 65 percent of the applicable cases at VUH.”

In addition to presenting treatment options, Wiz will give users the option to view informative screens on topics such as contraindications to heparin therapy and comparative benefits of various diagnostic tests for DVT. For confirmed cases, the system will present weight-based dosing guidelines. Wiz will automatically alert users of aPTT results that are out of range, and will flash a reminder if results are left unchecked for six hours.

The kicker is that the system has been programmed to automatically furnish data on compliance with the guidelines.

“We’ll be using data from the lab, by way of DB2, to examine practice in terms of how well we anticoagulate and over what period of time,” Burnett said. “Most people recognize that giving people information will lead to a change in behavior. We plan to share this data with residents on a regular basis.”

Dr. Antoine Geissbuhler, creator of WizOrder, led initial programming efforts on behalf of the committee. Geissbuhler has since left Vanderbilt to return to his native Switzerland. Dr. Jack Starmer, clinical fellow in biomedical informatics, has taken on programming support for the project. Burnett noted that special credit for this project is also due to Drs. David Gailani, Allen Kaiser and Anne Thomas.

The committee is also considering strategies to support prevention and evaluation of thromboembolic disease. For more information contact any of the following committee members: Drs. Lonnie Burnett, John Cousar, Allen Kaiser, Anne Thomas.