Ambient Warning and Response Evaluation (AWARE) System: Growing Under the Sun

Pablo FrancoHIMSS Clinical Informatics Insights

In order for disruptive innovation to be successful, a great deal of time needs to be invested in design during pre-production phase, followed by skillful delivery of the product to the end-user. Since its development in Mayo Clinic Rochester, AWARE was designed based on the voice of the costumer and redesigned in a clinical simulation center and during deployment in multiple specialized intensive care units (ICUs). The main features of AWARE include unique logical display of high value data, shared multidisciplinary communication platforms and evidence based decision support tools.

When I moved to practice at the Mayo Clinic location in Florida where only a conventional Electronic Health Record (EHR) was available, it became clear that we had to spread AWARE across the organization. Over a year of project approval committee meetings was needed to start the project, after which it was still not as easy as plug-and-play. We had designed a great tool for the clinical end-user to apply when caring for the most complex patient populations but the problem remained how to convert the clinician to using AWARE when they already had a system in place that, although not as valuable, was familiar. It took another year of weekly meetings with information technology (IT), nursing informatics, programmers and clinicians until we were finally able to deliver a complete and accurate tool that could be used by clinicians for patient care while enhancing their experience. A significant amount of time was needed to do the necessary connections from the vendor of our EHR to AWARE which highlights the lack of standardize language across EHRs as a barrier that undermines patient care each time a new EHR tool is implemented.

During implementation, usual training sessions were completed as well as going beyond with use of many other quality improvement and education tools to show providers AWARE’s advantages. Most of the avid users have been providers who need high value data to make timely critical decisions. The non-decision making and non-ordering providers have not engaged as frequently. Although with reinforcement, they have adopted the use of the standardized communication platforms which were built into the program.

If we were to do this process over again, the most beneficial testament would be to have a standardized EHR language. A similar principle applies to data being generated by ICU related hardware (i.e. Ventilators, IV pumps and dialysis machines). Not having a testing environment where necessary adjustment could be made delayed the improvement “Plan-Do-Study-Act” cycles. Finally, the recognition AWARE has received since its implementation has been to our advantage, leading to a recent decision of the critical care strategic planning group to request standardization of hand-off communication in the ICU with AWARE; which will create more momentum to engage allied healthcare providers. Additionally, enterprise wide efforts now have the ability to standardize rounding tools and ICU checklists as well as others such as computerized algorithms for deteriorating patients. The future is bright for this novel ICU tool, something to be AWARE of!

About the Contributor
Dr. Pablo Moreno Franco is an Assistant Professor of Medicine at College of Medicine and a Transplant Critical Care Intensivist, also serving as Medical Director for the medical and surgical intensive care unit in 4North at Mayo Clinic Florida Campus. Dr. Moreno Franco did his Critical Care fellowship at Mayo Clinic in Rochester where he served as Chief Fellow for Practice and Quality Improvement. During which time he received awards for “Outstanding Clinical Achievements” and “Outstanding Teaching”. He has research interests in, ICU monitoring, Refractory Hypoxemia, Liver and kidney transplantation, Sepsis and Multiorgan dysfunction syndrome.  Dr. Moreno leads several quality improvement initiatives including the Mayo Florida Sepsis and Shock Response Team and also the Ambient Warning and Response Evaluation System (AWARE) project for Mayo Clinic Florida and Arizona.