title: A regional informatics platform for coordinated antibiotic-resistant infection tracking, alerting, and prevention.
abstract: BACKGROUND
  We developed and assessed the impact of a patient registry and electronic admission notification system relating to regional antimicrobial resistance (AMR) on regional AMR infection rates over time. We conducted an observational cohort study of all patients identified as infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA) and/or vancomycin-resistant enterococci (VRE) on at least 1 occasion by any of 5 healthcare systems between 2003 and 2010. The 5 healthcare systems included 17 hospitals and associated clinics in the Indianapolis, Indiana, region.
  
  
  METHODS
  We developed and standardized a registry of MRSA and VRE patients and created Web forms that infection preventionists (IPs) used to maintain the lists. We sent e-mail alerts to IPs whenever a patient previously infected or colonized with MRSA or VRE registered for admission to a study hospital from June 2007 through June 2010.
  
  
  RESULTS
  Over a 3-year period, we delivered 12 748 e-mail alerts on 6270 unique patients to 24 IPs covering 17 hospitals. One in 5 (22%-23%) of all admission alerts was based on data from a healthcare system that was different from the admitting hospital; a few hospitals accounted for most of this crossover among facilities and systems.
  
  
  CONCLUSIONS
  Regional patient registries identify an important patient cohort with relevant prior antibiotic-resistant infection data from different healthcare institutions. Regional registries can identify trends and interinstitutional movement not otherwise apparent from single institution data. Importantly, electronic alerts can notify of the need to isolate early and to institute other measures to prevent transmission.
authors.affiliation: Department of Medicine, Northwestern University, Chicago, IL 60611, USA. abel.kho@nmff.org
authors.forename: Abel N
authors.initials: AN
authors.lastname: Kho
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Doebbeling
authors.forename: John P
authors.initials: JP
authors.lastname: Cashy
authors.forename: Marc B
authors.initials: MB
authors.lastname: Rosenman
authors.forename: Paul R
authors.initials: PR
authors.lastname: Dexter
authors.forename: David C
authors.initials: DC
authors.lastname: Shepherd
authors.forename: Larry
authors.initials: L
authors.lastname: Lemmon
authors.forename: Evgenia
authors.initials: E
authors.lastname: Teal
authors.forename: Shahid
authors.initials: S
authors.lastname: Khokar
authors.forename: J Marc
authors.initials: JM
authors.lastname: Overhage
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D015331:Cohort Studies; D018563:Disease Notification; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification*; D004812:Epidemiologic Methods; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D006760:Hospitalization; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D008297:Male; D008491:Medical Informatics Applications; D016106:Methicillin Resistance; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D008875:Middle Aged; D015995:Prevalence; D012042:Registries; D020713:Vancomycin Resistance; D055815:Young Adult
keywords: MRSA; VRE; clinical decision support; health information exchange; infection control