Mitigate new patient safety risks caused by health IT implementation

Joseph Kim

For the past few years, the primary focus among health IT experts has been around the meaningful use of electronic health records, but the subject of patient safety issues from health IT implementation has not kept pace. These days, a growing number of patient safety organizations are raising their voices in the midst of health IT adoption, training and transitions.

Although meaningful use has three stages, the biggest hurdle for many organizations was transitioning from a paper-based process to an electronic record system through the painstaking task of implementation. Now that most hospitals and major health systems are using some type of EHR, they are focusing on stages 2 and 3 of the meaningful use incentive program, but what about patient safety in the midst of these process-oriented transitions?

This year at the HIMSS 2014 annual conference, a pre-conference symposium titled "Patient Safety: Making Healthcare Safer -- IT Challenges and Solutions" addresses that question. Presenters will discuss issues such as safety surveillance and response at the organizational, regional and national levels. The speakers are from the Association for the Advancement of Medical Instrumentation and from the ECRI Institute, an independent, nonprofit organization that researches the best approaches to improving the safety, quality and cost-effectiveness of patient care.

In 2013, the ECRI Institute published a white paper titled the "Top 10 Health Technology Hazards for 2013." On the list, we found several issues all directly linked to the use of health IT. The ECRI Institute listed things such as alarm hazards, patient data mismatches in EHRs, interoperability failures and caregiver distractions by mobile devices.

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No healthcare organization has completely solved the perplexing challenge of dealing with alert fatigue in today's health IT environment. As clinical decision support tools are integrated into computerized physician order entry systems, alerts are becoming more cumbersome for physicians and nurses who are trying to maintain a streamlined workflow in their busy environment.

The ECRI Institute mentions an initiative at the Johns Hopkins Hospital where a team analyzed alert data at each hospital unit and made incremental changes while measuring the effects of those changes. Eventually, the team was able to significantly reduce the number of clinically insignificant or non-actionable alerts, but the definitions of "clinically insignificant" or "non-actionable" remain highly debated within the medical community. After all, an alert that is viewed by an experienced clinician may seem insignificant. However, that same alert may be very significant to a medical student or a physician trainee at an academic medical center.

There are many other challenges beyond alert fatigue that directly impact patient safety. Clinicians and administrators continue to struggle with the challenges associated with copy and paste within a patient record. This habitual behavior often leads to mismatching information pertaining to a patient throughout a hospital stay. Yet, this behavior remains pervasive because of the time savings associated with copying and pasting common attributes within a patient record. Meanwhile, health IT administrators remain focused on interoperability challenges and meeting requirements for effective health information exchange so that they can keep up with meaningful use requirements.

Since the organizational infrastructure of patient safety has traditionally been built around paper-based processes, hospitals and health systems are developing policies and procedures designed to assess user workflow, identify weak spots and make incremental improvements to improve safety in the new environment of a digital hospital.

About the author:
Joseph Kim is a physician technologist who has a passion for leveraging health IT to improve public health. Dr. Kim is the founder of NonClinicalJobs.com and is an active social media specialist. Let us know what you think about the story; email editor@searchhealthit.com or contact @SearchHealthIT on Twitter.

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