How CST Cerner is helping to reduce the transmission of infectious diseases

​With COVID-19 now in our lives, controlling the spread of infectious diseases is top of mind. And over the past seven months, CST team members have been working tirelessly to improve infection control functionality in CST Cerner so that health professionals can do just this.

"It's all about keeping patients and staff safe by reducing the transmission of disease," says Lori Campbell, clinical informatics lead with the Clinical & Systems Transformation (CST) project. "Our goal is to make it easier for infection control practitioners to complete their processes, including monitoring, but also to automate as much as possible so that best practices and policies are being followed. I'm confident they're already doing the steps, but we are automating it and improving communication across the care team." 

With so many pieces of the care puzzle hinging on having accurate infection control and isolation information, the new CST Cerner enhancements will help protect patients and staff from getting an infectious disease, or from unintentionally spreading it. It's also about freeing up infection control practitioners from manually updating and maintaining information in the system, so they can do all their other important work. 

Four new ways CST Cerner is helping support infection control

1. Automating patient isolation rules 

Lori — working with Issa Robedillo, CST clinical Informatics specialist, Nicole Van Luchene, CST clinical analyst, and supported by CST project manager, Michelle Wright — recently streamlined the automated isolation rules that are in place for several diseases. This means that, as of September 2, 2020, clinicians using CST Cerner no longer have to enter those orders manually. An added benefit is that staff can trust that isolation orders are being put on their patients, without having to go and review each patient as they're admitted.

"Previously, sometimes the patient would have multiple isolation orders with different reasons, and it wasn't always clear to the clinician why a particular type of isolation was required and when it was safe to remove that, or very important to maintain it," explains Lori.

"We have now reduced the number of duplicates so that it's clearer the type of isolation the patient should be on — whether droplet, contact or airborne precautions. We also implemented a replacement strategy for the reason for isolation, so it's always the most up-to-date." 

2. Reinforcing COVID-19 precautions at CST Cerner sites 

COVID-19 requires the use of droplet and contact precautions, and, depending on the patient's scenario, airborne precautions could be required as well. With new CST Cerner functionality added on September 2, if a patient is registered in the ED and suspected of having COVID-19, this is entered in the 'reason for isolation'. Automating isolation for suspected cases helps notify the infection control team in a timely manner and ensure appropriate bed placement for isolation purposes. 

Similarly, if a COVID-19 order is placed in the system and the patient does not already have an isolation order, the system automatically places one to remind staff. This isolation type follows the patient. So, if they have to go to medical imaging to get a chest x-ray done, it prints out in medical imaging so staff know to take the right precautions to keep themselves and patients safe. The alert is also on the banner bar of the patient's electronic chart so, before any clinician goes in a room, they are aware.

"The system alerts also reinforce the signs on the doors, which tell staff what PPE they need to put on before entering," says Lori. "It's better information to help clinicians with important decision-making." 

3. Better view of patients with infectious bacteria

A patient with a known antibiotic-resistant organism (ARO) is noted for isolation in CST Cerner when they get registered in the ED, so that the staff will know to put them in a certain area to prevent spread. From September 30, a new report will give infection control practitioners a better view of information pertaining to the patient's historical alerts.

"This report will help them to track down when it was first identified that the patient had an antibiotic-resistant organism and help them do follow-up on that," says Lori, adding that there are over 16,000 patients with alerts for AROs in the system.

"It doesn't seem like a big thing, but it will actually help a lot, because instead of looking through five years of lab results, they can use this report to find out that the alert was applied in January 2017 and then just focus on the lab results for that month." 

4. System flag to help patients with Cystic Fibrosis  

Another upcoming change will help patients with Cystic Fibrosis (CF) at St. Paul's Hospital. More than 4,000 Canadians have CF — the most common fatal genetic disease affecting Canadian children and young adults. At St. Paul's, the policy is that every CF patient gets isolated with contact precautions when admitted, because they're at a higher risk of acquiring certain respiratory infections from other CF patients.

While St. Paul's has had this process in place for a while, Lori's team is giving it visibility in the CST Cerner system. The goal is that, within the next two months, the system will have a flag for these patients to more readily identify if the patient has chronic lung infection with bacteria that poses serious risks (to someone else with CF) as an automatic reminder. If not, they are admitted to the CF unit, Lori explains. But if they do have CF and a chronic infection with a bad bug, they go a completely different unit to reduce the risk of spread from one patient to another. 

"Automatic alerts in CST Cerner will notify bed booking staff of any bad bugs our CF patients are harbouring, which will ensure our patients are admitted to the appropriate ward in the hospital to keep them safe and to reduce the risk of patient-to-patient transmission," says Dr. Bradley Quon, physician and researcher with the CF Clinic at St. Paul's Hospital.

"Many of our patients are also fearful of acquiring new infections such as MRSA (Methicillin-resistant Staphylococcus aureus) onsite from hospital staff and therefore a universal contact precautions alert will be another measure to help protect them. Acquiring a bad bug in the hospital can have devastating consequences to their lung health and thus must be prevented, and CST Cerner will help facilitate this."

Why CST Cerner enhancements are important for reaching our digital health goals

Although the CST team's efforts ramped up in this area when COVID-19 appeared, this work has been on the radar since St. Paul's Hospital and other Providence Health Care sites went live in November 2019.

Together, with infection control experts, they identified and prioritized potential improvements before completing the work needed to present options to key decision-makers from VCH, PHSA and PHC. Once the options are chosen, the enhancements are built and tested, education is provided, and they are then implemented as part of ongoing improvements.

For Lori, a Surgical and ICU nurse who worked in professional practice before joining the CST project five years ago, this is all in pursuit of improving the flow of information.

"I want to help improve the way that clinicians interact with the patient chart and the patient record — to help them do their clinical work without having documentation and charting as a barrier."