As providers get on with implementing meaningful use stage 2, the medical errors that can be caused directly or indirectly by electronic medical records are beginning to get more attention. Earlier this month, the Patient Safety Organization that’s part of the Philadelphia-area ECRI Institute published a report flagging up safety pitfalls such as people entering the wrong data in the wrong patient file or systems generating incorrect medication. That same report also provides a checklist of issues for healthcare facilities to consider before healthcare IT systems are implemented or during that process.
An Institute of Medicine report on health IT safety published two years ago noted that the time when a healthcare facility begins to use a health IT system is “fraught with patient safety risks” because this is the time when problems are most likely to appear. So of the many, many recommendations made in ECRI’s report to improve patient safety, here are just 10:
Before implementation
Market Trends to Watch for Health Systems and Their Specialty Pharmacies
The future looks bright for the integrated specialty pharmacy model – for health systems, providers, and most importantly, for patients.
1. Go to healthcare facilities that have adopted health IT systems, especially if they are the same as the ones your facility is considering adopting to learn about their experiences and lessons learned.
2. One of the tricky things about phasing in a healthcare IT system is that each hospital, even within a healthcare system, has its own approach to carrying out various tasks. So you should evaluate current clinical and administrative work practices, especially for clinical orders, documentation, and policies and procedures that will be affected by the project. Get user input to adjust this work flow around the electronic ecosystem and equally use this input to generate a list of criteria to evaluate the system’s usability.
3. Get vendors to commit to working with the facility’s IT department to build system interfaces or commit at no extra charge to providing the documentation for the facility to build and maintain its own interfaces or to contract with a third-party supplier to do that.
During implementation
The Funding Model for Cancer Innovation is Broken — We Can Fix It
Closing cancer health equity gaps require medical breakthroughs made possible by new funding approaches.
4. Make sure relevant staff are trained on what to do when the health IT system goes down and the backup measures need to be implemented. Encourage them to share any problems they are having, particularly with ease of use.
5. Have a protocol in place to deal with health IT system problems that can affect patients.
6. Use “forcing functions” like requiring users to re-enter patient names or gender and age before a record opens to reduce the chance of getting the wrong patient record. According to a study by JAMA, researchers at one New York hospital found that implementing this safeguard reduced wrong patient orders by 41 percent.
7. To reduce the frequency of errors involving placing orders in the wrong patient’s chart, researchers at a children’s hospital made two changes to the CPOE system. The group used a a verification screen in the ordering process for the provider to confirm that the patient’s name is correct. They also added a picture of the patient on the verification screen. The changes led to a 75 percent decrease in wrong patient order errors.
8. User interfaces make it easy to undo actions if a mistake is made without losing important data. Limit clinical decision support alerts to ones that are essential for safe patient care to minimize distractions and prevent alert fatigue.
9. Don’t let staff use the health IT system until they’ve proven they are competent to use it. In the first few months of implementation, give people who use the system one-on-one support, 24 hours a day, seven days a week.
10. Set up parameters to monitor and gauge the health IT system’s performance and effectiveness. Encourage a culture where people recognize the need to report events and near misses involving the health IT systems. There may be reason to hope that electronic medical records could do a lot to make fostering this sort of culture easier.