VTE (Venous Thromboembolism) Risk Calculator is an interactive application, integrated with SMART Platform, that helps the physicians and care givers prevent hospital acquired VTE. By integrating the calculator with the electronic health record, the usability of the tool for clinical users is enhanced.

Background

Venous Thromboembolism (VTE) is the most common preventable cause of hospital death (AHRQ 2008).  Nationwide more people die from VTE than AIDS, Breast Cancer and highway fatalities combined.  Clinical trials provide irrefutable evidence that thromboprophylaxis (using mechanical methods to promote venous outflow from the legs and antithrombotic drugs) reduces VTE.  Currently, the Joint Commission has developed VTE prophylaxis measures, which are also a part of Meaningful Use.

To help prevent hospital acquired VTE, Texas Health Resources (THR) IT department embarked on a journey to gain consensus on VTE best practices by working closely with key stakeholders and end users; developed an interactive clinical decision support application using rapid application development techniques; then integrated this application into our electronic health record (EHR) to help guide our clinicians. Evidence of the success of this project is illustrated by the over 20% reduction in post-operative pulmonary embolism/deep vein thrombosis since this project’s deployment. This interactive tool is now integrated with the SMART EHR to help guide the clinicians in taking preventative measures against hospital acquired VTE.

Business Objectives

Our mission is to improve the health of the people in the communities we serve.  To help fulfill our commitment to this mission, this project’s goal is the prevention of hospital acquired VTE by 1. early identification of patients at risk and 2.) appropriate timely intervention strategies as per national guidelines and evidence based practices. 

Application

Our Smart Platform application is based on the Caprini Risk Assessment tool, developed by Dr. Joseph Caprini, professor of surgery at the Feinberg School of Medicine at Northwestern University and a nationally recognized expert on VTE prevention. By integrating the application with an electronic health record (EHR), the accessibility and usability of the risk assessment tool is enhanced.

 The application also has the capability to send the VTE risk score as an HL7 interface message to EHRs as a test result. The benefit of this result is that this information can be used to trigger clinical decision support. In the future, if the SMART Platform EHR is able to support this or another type of Web service to accept information from our app, we will be able to replicate this capability.

Benefits

Benefits resulting from this initiative include:

• a reduction of post-operative pulmonary embolism/deep vein thrombosis by over 20% since implementation and adoption of the VTE risk assessment, order sets and associated clinical decision support tools.

• increased utilization of VTE prophylaxis using standardized VTE risk assessment tools and evidence-based order sets.  Prior to this implementation, VTE prophylaxis could be overlooked.  Now clinicians either use the order set or document the reason it wasn’t used.
• demonstration of a Meaningful Use component.  Integrating the VTE risk assessment application with our EHR extends the use of our EHR and illustrates our ability to improve quality with health information technology, which helps us qualify for increased incentives from ARRA legislation.
• improved efficiencies.  Time is saved as 25% of the VTE risk assessment is auto-populated with patient data and calculations are made electronically. No longer are clinicians manually completing paper assessments and manually computing scores.  It is done automatically.
• enhanced collaborative information sharing and standardization of best practices. Since VTE risk assessment results are stored back into the EHR, this information is accessible by any other clinician who is treating the patient. Rather than clinicians using a variety of VTE risk assessments, now our clinicians are using a standardized, evidence-based VTE risk assessment tool.

Transportability

This VTE risk assessment tool along with evidence-based order sets effectively addresses a quality issue that is common to all health care providers.  Since the VTE risk assessment tool is modular in nature, it serves as a model to apply to other quality issues.   By using industry standard tools to develop an application that addresses a universal patient safety concern, Texas Health Resources (THR) has created a clinical decision support tool that can be readily implemented by other health care organizations.