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 1
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. 2
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 3
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Health information technology enables substantial improvements in health care quality and safety, compared to paper records To be continued 5
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 6
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 7
**HIMSS Analytics, February 2012 8
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 #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 #6: Mislabeled specimens **The full lists can be found at www.ecri.org/2014 hazards 9
Analyzed 3,099 EHR related events 10
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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. 12
Because of EHRs, care has/is... Has improved patient safety 47.6% The same as before 28.6% Less safe 23.8% 0% 10% 20% 30% 40% 50% 13
...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) 14
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 15
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 16
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 17
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 18
ONC will incorporate HIT safety in postmarket 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 19
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 20
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 21
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? 22
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 23
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 24
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 25
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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-researchersimplementers/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 29
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 30
Contact Info: Mary Erickson RN, Account Manager 406 521-0488 merickson@mpqhf.org www.healthtechnologyservice.com 31