KLAS: Pros and cons of health IT systems for managing antibiotic resistance threat
When it comes to helping hospitals intervene, track internal metrics and use antimicrobial stewardship systems to their fullest potential, certain vendors have varying points of strength and weakness.
KLAS evaluated different software products – from BD, Epic, Premier, Vigilanz, Wolters Kluwer and others – that can help hospitals manage their antibiotic use, helping ensure they administer the right drugs to the right patients in the right doses for the right duration.
The problem AMS systems address
More and more hospitals are pursuing comprehensive strategies to govern their antibiotic use. In the effort to improve patient safety and comply with increasingly prescriptive guidelines, antibiotic stewardship programs aim to stave off antibiotic resistance and protect against adverse events such as Clostridium difficile infection.
The Joint Commission announced a new standard that went into effect at the beginning of 2017, in fact, that details how antimicrobial stewardship initiatives should be staffed and what their protocols should achieve.
"Improving the use of antibiotics is an important patient safety and public health issue as well as a national priority," according to the Centers for Disease Control and Prevention – which has found that as many as 50 percent of antibiotics prescribed in U.S. hospitals are unnecessary or inappropriate, and has launched numerous initiatives meant to promote smarter use antibiotics in acute care settings.
What KLAS found about AMS vendors
"As is often the case in markets where many users are switching from manual to automated processes for the first time, users' initial reactions to their AMS technology have been positive," according to KLAS researchers.
For instance, Premier and Wolters Kluwer do best with arming clinicians with real-time data for timely interventions, according to the report
"Premier users highlight the real-time notifications," according to KLAS. "Wolters Kluwer customers like the flexibility of the rules. Both can make on-the-fly adjustments to the rules and are able to build complex, prioritized rules that strengthen provider interventions and lead to better overall outcomes, such as decreased days of therapy and improved drug optimization."
Epic, meanwhile, does well integrating lab, EMR, and pharmacy data into a single AMS tool, though customers said they'd like better drill-down functionality for reports. And users of VigiLanz technology like its custom-built notifications, but said system adjustments are too dependent on vendor resources which can cause delays.
Such customization is a powerful strong suit, according to the report, which finds that VigiLanz customers value those capabilities and its robust interfaces, which successfully pull in data from many areas.
"The ability to track internal AMS metrics is crucial to a good AMS program because it enables users to see trending and benchmarking data," researchers said. "It can be tricky to do well because data from many different sources must be aggregated, analyzed, and made easy to digest."
KLAS added that "the core functionality of any AMS system – the custom rules and the antibiogram – is what allows users to identify opportunities for intervention and track internal metrics."
Vigilanz’s rule sets, meanwhile, are highly customizable but often rely on the vendor’s help, researchers said. On the other hand, Wolters Kluwer clients like being able to customize and create rules on their own without having to depend much the vendor.
Meanwhile, "operationalizing Epic’s tools requires significant internal resources and expertise, which can lead to frustration," according to KLAS, and although Premier users "can adjust the rules on their own, the tool is complex and has a high learning curve. Likewise, the complexity of BD’s tool makes it difficult for some customers to get all the customization they want."
Whichever vendor they use, most hospitals told KLAS they want more-advanced antibiogram functionality, with improved drill-down capabilities and the opportunity to examine more types of data.
AMS programs are a relatively new phenomenon, and hospitals tend to appreciate guidance and expertise from their vendors, according to the report. In that respect, VigiLanz proactive customer support has led to its top overall satisfaction rating, researchers said.
Wolters Kluwer and BD clients also like those companies' knowledgeable support, but both say they'd like to see their customer feedback implemented more quickly. Premier has focused on up-front training for its complex system, according to KLAS, while Epic users "feel the overall development is improving but want more guidance for optimizing the solution."