Utilization of a Computerized Clinical Surveillance System to Increase Acute Myocardial Infarction Core Measure Compliance

Abstract

Clinical surveillance systems (CSS) are utilized by many health care institutions to help identify at-risk patients, prioritize care, improve the clinical services provided, and increase compliance with the Center for Medicare and Medicaid Services (CMS) core measures. This study will assess the accuracy and practicality of a CMS acute myocardial infarction (AMI) alert, provided by the CSS Theradoc, designed to increase compliance with medications required at discharge in AMI patients. This is a single-center, retrospective cohort review to determine the sensitivity and specificity of the Theradoc CMS AMI alert. All patients with a Theradoc CMS AMI alert were analyzed for AMI occurrence and omission of CMS-required discharge medications. Secondary endpoints regarding alert times and quantity were also assessed to address the practicality of implementing the alert. Data were collected on patients with alerts occurring between January 1, 2011, and December 31, 2011 (N = 962). The Theradoc CSS alert was found to have a sensitivity of 100% and specificity of 4.79%, signifying a gross amount of false positives. No modifications to the alert definitions or timing were able to increase the specificity to >10%. Regardless of the high sensitivity, the Theradoc CMS AMI alert does not have the appropriate level of specificity to utilize at the study institution at this time.