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Expertise, Accrued Over Time

Improving healthcare by staying abreast of the changing needs and challenges of medical professionals, using technology and insight.

Dr. Diane Homan, Vice President of Clinical Innovation and Chief Medical Information Officer at Rush-Copley Medical Center: “I vividly remember the day in October 2009 when a man was admitted to my hospital with tuberculosis (TB). Our tests identified a very specific and rare form of the TB bacterium that we’d only seen once before in the county, two years earlier.”

That December, two more men with the same strain of TB were admitted to Rush-Copley, in the Illinois town of Aurora. Staff were puzzled, until they made a crucial discovery. “We have a transient community, with lots of people coming here from Mexico. So we always have a rate of TB, but with a common genotype. This type was uncommon,” says Dr. Homan. “Our manager of infection prevention looked at the information and said: ‘They’re all coming from one specific homeless shelter in Aurora.’”

It was the start of a life-saving fight, demanding human perseverance and an innovative use of technology, including Wolters Kluwer’s clinical knowledge systems.

You might well think that TB has been wiped out. Well, it has not. It is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent. Over 95% of TB deaths occur in low and middle-income countries. That doesn’t mean it stays there: TB-infected migrants carry the disease with them. Once the disease had been detected in Aurora, it was vital to prevent it from spreading further. “We realized we needed to further screen the community. People could be exposed in other ways, like volunteering at a shelter or through contacts in the community where homeless people tend to congregate, like the local library or bars,” says Dr. Homan.

Massive Screening
Rush-Copley launched a massive screening program that initially evaluated more than 800 people. As a result, 312 latent cases and 45 active cases were identified and treatment administered.
With the aid of Wolters Kluwer’s  ProVation Order Sets and  UpToDate, Dr. Homan’s team devised a truly innovative solution. ProVation Order Sets delivers evidence-based treatment protocols integrated with UpToDate, a best-in-class, physician-authored clinical decision support resource.

“Homeless people may not have frequent check-ups, but they do show up in emergency departments. We embedded tuberculosis screening as a required element of screening in numerous order sets,” the doctor says. It was embedded into staff workflow so that even hyper-busy emergency room doctors and nurses couldn’t forget to check for TB when patients came in with a cough, fever, or night sweats.

“If you just rely on emergency room staff remembering to screen, it’s much more sporadic. You’re less likely to identify those with latent phase TB. More patients will evolve into the advanced active phase of the disease, which is more expensive to treat and increases the risk to the patient and the community,” says Dr. Adam Lokeh, Vice President of Clinical Development & Informatics at  Wolters Kluwer Health.

“The major problem was that patients with tuberculosis don’t need to stay in the hospital – nor can they go back into the community. The Kane County Health Department wouldn’t let us discharge the patients, because they had no known address to be discharged to. They were concerned about exposing others in our community,” Dr. Homan says.

If we had all these patients in the hospital at the same time it would be a disaster. We worked with them to secure accommodation for this population of patients. It took months,” she adds.

Such persistence ensured a 97.4% completion rate for the treatment of active tuberculosis, an abnormally high rate. Because of the side effects of the medication, many sufferers – especially transient, hard-to-track groups – don’t complete their course of treatment.

Process Improvements
“One of the reasons for the success of treating active phases was that we provided them with housing during this time, as well as observed medication administration on a daily basis, provided through nurses from Kane County Health Department,” says Dr. Homan.

“We don’t improve health in communities by what we do while they’re in hospital. It’s about what we do in the community,” says Dr. Lokeh, who combines his role at Wolters Kluwer with part-time work in a children’s hospital trauma department. This enables him to remain abreast of the changing needs and challenges of the medical professionals that Wolters Kluwer serves.

“We’re not going to be able to completely rid the world of tuberculosis; we’ll only be able to manage the outbreaks,” he says. “Rush-Copley did that so successfully because they were able to use the technology they had, the information they had, and the cooperation of the community, to deal with this critical issue before it got much larger.”