Interactive Medical Intelligence – The future is now

Author: G. Pregenzer MD, FACOG, FACS, FICS

Affiliation:  Somerset Medical Center;

Robert Wood Johnson University Hospital; Somerville, New Jersey, USA

&

Verify-IMI, Warren, New Jersey, USA

Presenter:  Gerard Pregenzer MD, FACOG, FACS, FICS

 

XXIV European Congress on Perinatal Medicine

Florence, Italy

June 6, 7      2014

 

Introduction

The application of the computer and Information Technology has had the promise of dramatically improving the medical care worldwide for over a decade now.

The landmark report in the United States by the Institute of Medicine in 2000, “To Err is Human, building a safer Health System” indicated that up to 90,000 Americans die from medical errors largely attributed to illegibility of medical orders and directives.

The current electronic medical record systems used worldwide certainly solve the illegibility concerns. But the question remains, what about true quality of care?

The vast majority of systems today are used for tracking billing, and checking on inventory issues. None of the systems evaluated by the authors have a check and balance system to assist the clinician in determining if a medical mistake has occurred.

A system was developed which, we believe, has taken Information Technology in medicine to the next level.

The new system is not a medical record system but rather an interactive medical intelligence system. Such a system has the ability to assist the clinician to accurately, efficiently and rapidly deliver obstetrical care and dramatically reduce, if not, eliminate medical errors.

Material and Methods    

Seven busy obstetrical practices were selected to transfer the patient clinical information from their system, both paper and electronic based, into the Interactive Medical Intelligence system.

Over a 1,000 pregnancies were followed until delivery.

The number of omissions or inactions identified by the Interactive Medical Intelligence system were determined and tabulated.

These were compared to the risks identified by the traditional methods and some of the standard commercial Electronic Medical Record vendors.

 
                             Missed by Obstetrical Practices
Annually in USA
Category # omissions/inactions per 1,000 4,300
History of HSV 8 34,400
History of LEEP 7 30,100
Maternal blood type not obtained 4 17,200
IVF not noted 7 30,100
Previous myomectomy 3 12,900
Sickle cell trait 1 4,300
USG of Cervix not measured in High Risk for PTL 8 34,400
(+) Group B Streptococcus culture 6 25,800
Family History or Autism, no Fragile X ordered 4 17,200
Short interpregnancy interval not noted 11 47,300

 

                 Missed by Obstetrical Practices
Annually in USA
Category # omissions/inactions per 1,000 4,300
Low MCV recorded but no action taken 8 34,400
Missing fields in chart 106 455,800
No maternal height recorded 90 387,000
No fundal height recorded 64 275,200
Elevated initial BP not acted on 15 64,500
Elevated BMI for appreciated for risk dystocia 11 47,300
Elevated BMI for appreciated for risk PTL 11 47,300
Short maternal stature not appreciated as risk for dystocia 5 21,500
At risk for GDM not offered early Glucose screening 12 51,600
History multiple abortions not noted as risk for PTL 7 30,100
Total 388 1,668,400

Conclusions

As the Institute of Medicine has indicated, humans are human and are prone to making mistakes.  When mistakes occur in obstetrics, the resultant problems can be lifelong for the neonate.   Extrapolated over the 4.3 million births every year in the United States, approximately 1,668,000 omissions or inactions occur in the care of the pregnant patient.  Some of these errors have the potential to lead to catastrophic outcomes for the child and family.  This would include a financial burden and a medical legal impact affecting the family, clinician and hospital.

The dream has been to utilize computer technology to help humans identify mistakes and take corrective actions.  This has not been realized until now with the development of Interactive Medical Intelligence.

In this system, data is collected during the history and physical exam.  Risks are identified and diagnostics are suggested.  The results of these diagnostics may further identify additional or refine the noted risks.  The system never forgets, and continues to remind the clinician of outstanding results or if another test needs to be ordered.  All abnormalities are noted on the front page so the clinician does not need to search the chart, especially in an emergency situation.

The Interactive Medical Intelligence system integrates with the commercial labs and interprets the data and does not depend on the commercial lab to identify abnormal labs.  We have identified at least seven (7) situations when the commercial lab reported an abnormal result but did not flag the result and the result was not in red print.   Unfortunately, in three situations, permanent harm occurred to the baby and litigation followed.

We believe all clinicians should use an Interactive Medical Intelligence system to act as a “check and balance” system to help protect the baby, mother and clinician.

This new system, Verify-IMI, is an interactive medical intelligence system.  Such a system has the ability to assist the clinician to accurately, efficiently and rapidly deliver obstetrical care and dramatically reduce, if not, eliminate medical errors.