Patient safety joins list of EHR concerns

We have often commented on studies that show low physician productivity and frustration with electronic medical records, and how difficult it is to quickly get the key facts needed in the clinical trench. These are common themes.

Now a new concern has emerged with this far-reaching technology: patient safety.

In “An analysis of electronic health record-related patient safety concerns” by The Institute of Medicine published in JAMIA (the Journal of the American Medical Informatics Association) the authors conclude:

Most (94%) safety concerns related to either unmet data-display needs in the EHR (ie, displayed information available to the end user failed to reduce uncertainty or led to increased potential for patient harm), software upgrades or modifications, data transmission between components of the EHR, or ‘hidden dependencies’ within the EHR.

But human beings always have a role to play and are part of the complex equation leading to both good and bad care decisions.

Most often, non-technical dimensions such as workflow, policies, and personnel interacted in a complex fashion with technical dimensions such as software/hardware, content, and user interface to produce safety concerns.

Modern Medicine in its coverage of the study (see “Complicated, confusing EHR pose serious safety threats” – you’ll need a free login to read it) quotes author Dr. Hardeep Singh: “It’s not just the technological complexity, it’s also the social aspect around technology.”

The article uses a great example of this: a pharmacist makes a data entry error and inputs a higher dose of a diuretic than normal. A warning appears on his screen that is known to have a high false-positive rating, so the pharmacist overrides the warning and the incorrect dose is subsequently administered to the patient.

Even the most sophisticated EHR implementations should continuously monitor for safety issues, the authors advise.

Marla Durben Hirsch at FierceEMR has also summarized the report in “EHR-related patient safety problems persist ‘long after’ implementation” as well as reviewing the controversy around the ONC’s polemical IT health and safety center.

Our takeaways:

  • Poor user experience design and extraneous information contribute to safety concerns
  • Humans/technology interaction works best when each provides the right checks and balances
  • EHRs once deployed need continuous improvement to make it easier for humans to do their part
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CEO Mike Doyle joins Big Data and Decision Making Panel at Connected Health 2014

QPID Health’s Mike Doyle has been invited to join the panel on Big Data and Decision Making at the Connected Health Symposium 2014, to be held October 23-24, Boston, MA. The conference, which is in its 11th year, is organized by the Partners HealthCare Center for Connected Health. Joe Kvedar and his team create and study models for healthcare delivery that connect patients and providers using innovative technologies. We are pleased to support this annual meeting of 1200 physicians and other providers, health plan leaders, policymakers, patient advocates and technology innovators.

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From “scavenger hunt” to data made “smart”

We find a lot of synergy with the observations and vision expressed by Dr. Donald Voltz in the article “Electronic Medical Records – Past, Present and Future” published on HITConsultant.net.  Dr. Voltz sheds light on a pain that all of our clients (even those with the most advanced medical record systems) face:

Currently, I have to look in multiple places within EMRs to gather all of the relevant pieces of information to manage a patient’s complaint or condition. This reminds me of a scavenger hunt…. Switching between different locations to gather vital sign information, review past medical history, and laboratory studies is not only manual, but data can be entered in different ways, depending on the healthcare provider who entered the information in the system.

To solve this problem, Dr. Voltz prescribes a solution in which patient data is made “smart.” He sees a future in which systems align medical professionals with data that is “collaborative, not passive … delivered to those who need it, when they need it, with all the data in one place.”

We wholeheartedly agree and are delivering on this now. QPID’s Q-Guide solution in use at Mass General Hospital is a great example. It delivers the right data at the right time into the workflow for ordering, approval, and scheduling of surgical procedures.

As described by Rajiv Leventhal in Healthcare Informatics (“An Innovative Approach to Pre-Authorization At Mass General Hospital”):

Used during the pre-operative decision making process, the application aims to help clinicians apply complex guidelines-based decision criteria to each patient’s individual profile, and generates a recommended approach and risk score.

Q-Guide uses decision-making algorithms that are driven by combining the patient’s clinical evidence with the latest guidelines and personalized risk models.  The first release of the software includes guidelines for high cost, high use and resource-intensive vascular, cardiac, and orthopedic surgical procedures.

Dr. Creagh Milford of Partners described the outcome to Leventhal: “Diminishing the number of inappropriate procedures and having a high rate of appropriateness is a phenomenal story.”

Here’s to the future … now.

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