A computer-assisted recording, diagnosis and management of the medically ill system for use in the intensive care unit: A preliminary report

BACKGROUND: Computerized medical information systems have been popularized over the last two decades to improve quality and safety, and for decreasing medical errors. AIM: To develop a clinician-friendly computer-based support system in the intensive care unit (ICU) that incorporates recording, reminders, alerts, checklists and diagnostic differentials for common conditions encountered in critical care. MATERIALS AND METHODS: This project was carried out at the Medical ICU CMC Hospital, Vellore, in collaboration with the Computer Science Department, VIT University. The first phase was to design and develop monitoring and medication sheets. Terminologies such as checklists (intervention list that pops up at defined times for all patients), reminders (intervention unique to each patient) and alerts (time-based, value-based, trend-based) were defined. The diagnostic and intervention bundles were characterized in the second phase. The accuracy and reliability of the software to generate alerts, reminders and diagnoses was tested in the third phase. The fourth phase will be to integrate this with the hospital information system and the bedside monitors. RESULTS: Alpha testing was performed using six scenarios written by intensivists. The software generated real-time alerts and reminders and provided diagnostic differentials relevant to critical care. Predefined interventions for each diagnostic possibility appeared as pop-ups. Problems identified during alpha testing were rectified prior to beta testing. CONCLUSIONS: The use of a computer-assisted monitoring, recording and diagnostic system appears promising. It is envisaged that further software refinements following beta testing would facilitate the improvement of quality and safety in the critical care environment.