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E.H.R.’s and Improving Patient Safety - What Has Been the Real
Impact? Presented by: Mary Erickson, RN, HTS Accounting Manager
HTS, a division of Mountain Pacific Quality Health Foundation
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Understand how E.H.R.’s have affected patient safety on a national scale after review of available literature/statistics.
Understand how E.H.R.’s are affecting patient safety in Montana facilities after review of survey information.
Identify methods for improving patient safety in your own facility through facilitated discussion.
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A division of Mountain Pacific Quality Health Foundation
The Regional Extension Center for MT/WY
Assist healthcare facilities with utilizing Health Information Technology (HIT) to improve health care, quality, efficiency and outcomes
RECs "bridge the technology gap" and help navigate the EHR adoption & incentive program process
Expertise in HIT, Meaningful Use, PQRS, PCMH, Project Management, LEAN and HIPAA Privacy and Security
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“Health information technology enables substantial improvements in health care quality and safety, compared to paper records…”
To be continued…
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Effects of ePrescribing (2010) ◦ 63% fewer medication errors reported by patients
Promise to Reality: Achieving value of EHR (2011) ◦ Vermont Hospital reported:
60% decrease in near-miss medication events
20% increase in completion of daily fall assessment
National Perceptions of EHR adoption (August 2012): ◦ 94% of providers report EHR makes records readily available
at point of care ◦ 88% report their EHR produces clinical benefits for the
practice ◦ 75% report their EHR allows them to deliver better patient
care
**HealthIT.gov
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◦ Complete and legible record
◦ Opportunity for quickly/systematically identify & correct operational problems
◦ Manipulation/computing of data to make a difference for patients, for example:
Medication/allergy checking
Support diagnostic/therapeutic decision making
Consider all aspects of patient’s condition
Detect patterns of potentially related adverse events
Evidence based decisions at the point of care
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**HIMSS Analytics, February 2012
2014 ECRI Top 10 Patient Safety Concerns
2014 ECRI Top 10 Health Technology Hazards
◦ Top of the list -
Data integrity failures with health information technology systems
◦ #2: Poor care coordination with patient’s next level of care
◦ #3: Test results reporting errors
◦ #6: Mislabeled specimens
#4: Data integrity failures with health information technology systems
#7: Neglecting change
management for networked devices and systems
#8: Risks to pediatric patients from adult technologies
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**The full lists can be found at www.ecri.org/2014 hazards
Analyzed 3,099 EHR related events
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21 responses: ◦ 4 providers, 3 RN/LPN/Aide,
◦ 3 Ancillary, 5 IT staff,
◦ 3 Leadership/management
◦ 3 Other: coding, project management
12 facilities represented (9 hospitals & 3 clinics)
5 different EHR systems being utilized
Brief inquiries requesting positive & negative examples of EHR contributions to patient safety in their facility.
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Because of EHRs, care has/is ....
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0% 10% 20% 30% 40% 50%
Less safe
The same as before
Has improved
patient safety
23.8%
28.6%
47.6%
...if staff choose to not engage then it can become a hindrance and cause patient safety issues.
The safety/decision support mechanisms can be ignored if there are too many of them.
When the system is down, we cannot access the MAR for administration of meds.
Complications resulting from putting more work on the providers
Cost of need for redundant triggers in order to prevent things being missed due to failure of the technology (such as when orders are printed to the lab and the printer fails)
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Safer med passes was mentioned several times
Benefits of medication reconciliation & allergy checking
The availability of information to the providers of care has benefited the patient
More accurate prescribing and interface with pharmacy & drug interaction review
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“Health information technology enables substantial improvements in health care quality and safety, compared to paper records…
...Yet health IT can only fulfill its enormous
potential if risks associated with its use are identified, if there is a coordinated effort to mitigate those risks, and if it is used to make care safer.”
- ONC Patient Safety Action and Surveillance Plan, July 2013
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Two fundamental objectives: 1. Promote health care industry’s use of HIT to make
care safer and
2. To continuously improve the safety of HIT.
To be achieved using…
Three Plan Strategies 1. Learn – increase data and knowledge of HIT safety
2. Improve – target resources & corrective actions
3. Lead – promote a culture of HIT safety
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AHRQ will be making it easier for clinicians to report HIT related events
CMS will encourage use of AHRQ Common Formats in incident reporting programs.
AHRQ will develop Quality & Safety Review System to collect, aggregate, analyze patient safety reports and the contributing role of HIT
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ONC will incorporate HIT safety in post-market surveillance of CEHRT
Establish & advance HIT patient safety priorities
Support R & D of tools & best practices
Coordinate w/ NIST to develop safety design & testing tools for developers
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Investigate & take corrective action by contracting w/ The Joint Commission to proactively detect & address HIT safety issues
Encourage private sector leadership & shared responsibility ◦ EHRA voluntary industry code of conduct
Collaborate w/ FDA & FCC
Administer ONC HIT Patient Safety Program
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Collect & review data with an interdisciplinary team – use your existing safety or QA committee
◦ Perform EHR survey ◦ Review EHR related incidents trends
Use standardized categorization methods for type of incident & level of harm
Use an issue log
◦ Usage metric examples: Percent system down time
Percent alerts that fire
Percent alerts overridden
Interface efficiency, successful transmissions
Number of miscellaneous orders
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Prioritize the information ◦ Are there trends that could cause significant
harm?
◦ Are there trends causing significant end user dissatisfaction? Don’t ignore “user friendliness” complaints.
◦ What items are in your control to fix?
◦ What items need to be addressed by the vendor?
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Take ACTION! ◦ Refresher training ◦ EHR “Tip of the week” program ◦ Engage staff to be EHR Safety Champions ◦ Use root cause analysis to consider all aspects ◦ Review workflows ◦ Communicate & manage changes to network ◦ Collaborate with your vendor:
Be an active participant in vendor user groups and ongoing education
Submit appropriate feedback to your vendor through their processes
Give them real safety related examples to work with
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Monitor, share, and celebrate progress! ◦ Show staff the metrics you’re using
◦ Create an EHR Safety Scorecard – or make a few metrics part of an existing scorecard
◦ Be transparent with your issue log - post examples of items that have been reported and what the solution was
◦ Readdress what is still not working
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First thing to do is slow down. Before we get done with one initiative we need to start on the next to stay on-time with the next... becomes extremely difficult for IT and clinical staff to stay trained.
One of the barriers is that staff don't believe what can be achieved by using this tool, and put up a lot of resistance to change. If they can fully accept it and work with it and get everyone involved to make it usable it will work.
Our focus becomes meeting the minimum requirements for meaningful use and less about correctly installing good, safe system
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Heath Technology Services: http://www.healthtechnologyservice.com/
ONC Patient Safety Action and Surveillance Plan and Tools:
http://www.healthit.gov/policy-researchers-implementers/health-it-and-patient-safety
www.ecri.org/2014 hazards Guide to reducing unintended consequences:
http://www.healthit.gov/unintended-consequences/ Pennsylvania Patient Safety Authority:
http://www.patientsafetyauthority.org/Pages/Default.aspx
Improving usability for patient safety: http://jamia.bmj.com/content/early/2013/01/24/amiajnl-2012-001458.full?sid=ba934369-6981-411c-bed9-3d705a986a1c
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1. AHRQ HIT Safety Project Toolkit
2. Problem ID Starter Set Questions from HealthIT.gov
3. Post EHR Implementation Survey from NYC REACH
4. EHR Remediation Proposal Form
5. Issue Log Template from HealthIT.gov
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Contact Info:
Mary Erickson
RN, Account Manager
406 – 521 - 0488
www.healthtechnologyservice.com
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