HIMSS14: Building patient safety into health IT

ORLANDO—A panel speaking during the Patient Safety Symposium at the Health Information and Management Systems Society annual conference shared how they incorporated patient safety into health IT projects because technology has become part of patient care.

Children’s Hospitals and Clinics of Minnesota has been working to integrate EHRs and medical devices, said Bobbie Carroll, RN, MHA, senior director of patient safety and informatics. She shared their process for use of IV infusion pumps which includes multiple verifications. “The problems aren’t easy to fix,” she said. “Humans are doing this work and we’re fallible.”

Carroll said every unit is different when it comes to medication administration. “If you’ve watched one unit give a medication, you’ve watched one unit give a medication. We were astounded by the variation we had.” They began working to promote standard work and use of the same terminology.

Adverse events related to medication administration events have decreased by 37 percent, Carroll said. Staff nurses have reported situations where the process prevented a medication error. Data show an average 57 percent increase in smart pump drug safety parameter utilization since implementation and that level is sustaining, she said.

However, “it doesn’t happen on its own,” Carroll said. “We have to sustain it and keep awareness top-of-mind. We have to acknowledge its complexity and be transparent.”

Les E. Keim, VP of business systems analysis for Mercy Technology Services, shared his experience with a health information exchange (HIE) connection project.

The effort has presented numerous challenges to the HIE connection project. Guaranteeing that the right information follows the right patient isn’t helped by different state laws and the lack of good standard lab terms.

“We’ve taken a crawl, walk, run approach,” said Keim. “You can’t just flip the switch.”

Children’s National Health System implemented electronic physician documentation to help clinicians better communicate, said Brian Jacobs, MD, VP, CMIO and CIO.  The purpose of the physician note traditionally has been to justify the bill. Children’s National had a goal of creating a complete legible note that also served as a document that started to communicate. One note per care team per patient per day serves as a multi-contributor note, Jacobs said.

Jacobs and his team addressed upfront the problems they expected they might have with physician adoption. The idea of one note per child “was a strong selling point for achieving adoption.” Adoption was “tremendous,” he said, and within a few days it was very challenging to find any written notes.

Getting to a clutter-free, complete note is a “real challenge culturally,” Jacobs said. There were issues with physician hierarchy regarding where to place, say, cardiology v. pulmonary progress reports. And, the ability to copy and paste documentation is “a huge issue.” That ability is very convenient but physicians could bring forward inaccurate information.

The new note process integrates billing and diagnosis which is financially significant. Papers had been lying around, never submitted. “We were leaving millions on the table.”

In his own work as a critical care physician, Jacobs said he did not want to scroll through multiple notes to find the information he needed. Today, “what I want to know is written in one sentence. That’s the kind of clinician to clinician communication we should be striving for.”