Millennium tool helps to spot embolisms

St James’ Hospital in Dublin has worked with Cerner to develop a ground-breaking system to help identify and diagnose pulmonary embolism.

Pulmonary embolism – a blockage of the main artery of the lungs – can be difficult to diagnose, but has a high mortality rate if not detected and treated.

Doctors can use a CT pulmonary angiogram test to obtain an image of the arteries, if they suspect a pulmonary embolism may be present.

However, an audit of CTPA tests conducted by St James’ discovered that only 11% of 659 tests studied had been ordered for patients who actually had a pulmonary embolism.

In response, the hospital worked with Cerner to develop a computerised decision-based ordering system known as the CPTA Advisor.

The system, which integrates with the hospital’s Cerner Millennium electronic patient record, uses known risk factors and established clinical criteria to calculate a clinical prediction score that recommends whether or not to proceed with the CTPA test.

A second audit, conducted after the system was introduced, showed an increase in scans that were positive for pulmonary embolism. In addition, 20% of planned tests were cancelled, allowing the hospital to save almost £53,000 in one year.

Mary Keoghan, clinical director of radiology, told eHealth Insider that conducting unnecessary tests led to major inefficiencies. “Firstly for the patient – they received a large dose of radiation – and secondly, for the hospital – which was using up a lot of scanning time.

“With this system there’s a reduction in the patient impact, and for the hospital it’s a way to prevent the wasting of resources.”

Keoghan said clinicians had the ability to override the system, if they felt strongly that the test should be done. The second audit found 60 tests had been conducted in these circumstances.

However, Keoghan said they were all were negative. “Had they not been done, we would have saved a further 14,500 Euro (£12,760),” she said.

Amanda Green, managing director of Cerner Ireland, said Millennium supports the creation of automated clinical decision support tools, such as CPTA Advisor. “The tool is there and is part of the Millennium system. It’s just a question of what you want to include.”

Green said CPTA Advisor had generated interest world-wide, after the St James’ team was asked to present at the Radiological Society of North America conference in November.

“By Mary and the team presenting the results, we have been able to get the message out to international attention. We’ve had a lot of interest from North America specifically.”