All Entries in the "health information technology" Category
Patient safety in 140 characters
In honor of patient safety week, the National Patient Safety Foundation hosted a tweet chat, in which participants all follow the same hashtag (#keyword) to have a large conversation. If you missed it, you can read the conversation by searching twitter for “#PSAW2012.” I suggest checking it out (you don’t even have to have Twitter to conduct a search) for the resourceful links alone. Comment below or tweet @PSeditor if you joined and what you liked about it.
Here are some of the topics and facts brought up in conversation:
- Health literacy:
Twelve percent of adults have good health literacy
E-literature might help follow up with patients post-visit
MDs tend to interrupt patients after 18 seconds of speaking
- PSAW:
Getting PSAW recognized by more of the general public to spread awareness beyond the healthcare setting
Why PSAW is observed, recognized, but not celebrated
Next PSAW is March 3 –9, 2013!
Here are some resources brought up in conversation:
NSPF’s new “Ask Me” video
AHRQ’s “Questions are the Answer” video
IMSP has new tools and resources
Health Literacy: Reducing the Burden of a Complex Healthcare System
Patient Safety Week 2012: Informing the Journey, Not Changing the Destination
Checklists that patients and doctors follow can improve hospital care
Dreaming the dream (by Peter Provonost)
Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy
Do Electronic Medical Records Save Money?
What’s in a Name? Safer care, for one.
20 Tips to Help Prevent Medical Errors: Patient Fact Sheet
Cool app to help nurses, but does it foster bad habits?
Robert Freeman, a registered nurse at Beth Israel Hospital in New York, designed an mobile app for nurses that includes a database of more than 10,000 medical abbreviations and a news feed specific to the nursing profession, according to the New York Daily News. Freeman said the idea for a nursing app came to him when a colleague could not decipher an abbreviation on a patient’s chart. He indicates that nursing students will benefit the most from using the app as a learning tool, but that it will also improve efficiency and productivity for all nurses by quickly answering queries.
Freeman spent three months researching the information necessary to design “Nurse Net,” his free app. The app includes tools such as the Credentialer, which clarifies the abbreviations for various certifications and credentials used by health professionals, and the Abbreviation Assistant, which interprets abbreviations found on medical charts. “Nurse Net” became available in the Apple Store in November and has been downloaded more than 12,000 times since then.
I wonder how patient safety and quality professionals (yes, you) felt about these kind of apps. Personally, I worry about a nurse who, instead of clarifying an abbreviation (which may be a “do-not-use” abbreviation!) with the physician, consults an app. I would always prefer communication between humans when possible rather than consulting a third source, even if it is a bit of effort. Also, speaking directly with the physician might help avoid future issues with that physician’s notes. Is consulting the app a workaround here? And don’t forget, an app isn’t responsible for being right; it’s not responsible for being updated, and most importantly, isn’t responsible for keeping your patients safe. It’s a product, like anything else, even if it’s free and developed by a nurse with the best of intentions.
Are we teaching the right thing here? Weigh in below.
Technology, devices and equipment: More than just a purchase
One topic keeps popping up in the patient safety world, and in my humble opinion, I think we’re going to see much more of it. It’s the topic of how the devices we use in hospitals are understood and used. Technology and state-of-the-art equipment have the potential to make healthcare efficient and safer, but only if we slow down to learn how to use it, and in some cases clean it, correctly. I have this feeling that we are getting a bit ahead of ourselves with buying shiny new stuff, not worrying enough about continuing education of proper use, training, cleaning, and maintenance of equipment.
More than one hospital told me they had to take a step backward and re-implement handoffs after implementing electronic medical records. So much was documented in real time, staff often forgot to have conversations about the patient, leaving out a critical time to ask and answer questions.
Alarm fatigue is a prime example of too much technology at once, without forethought of potential side effects. Not only are nurses (understandably) tuned out, but the alarms add to the noisy environment in which the patient is trying to recover.
Endoscopy and colonoscopy equipment that hasn’t been cleaned according to guidelines are causing hospitals and physician offices to send thousands of regretful letters warning patients they may have been exposed to a host of bloodborne pathogens.
And I’ve already written extensively on whether radiation technology’s exponential expansion is too much to handle. We are getting better pictures, but at what cost? The radiation is getting stronger. Just because we can, doesn’t necessarily mean we should. And, there is debate as to whether technicians are undergoing enough training to use complex machinery. Machines only do what we tell them, and if we tell them incorrectly—especially in the case of radiation therapy—we are certainly doing more harm than good.
To echo a well known web-spewing superhero, with the power of new equipment and technology comes great responsibility. Providers should be educated and trained on using the equipment around them properly, and ensure they are well cleaned and maintained. We cannot afford to get distracted by wondrous EMRs or equipment. We must remember that it is all a means to an end that is better care. If the means actually makes care less safe, we are failing.
We need to be constantly asking ourselves whether we are doing everything possible to ensure new technology and equipment make a safer environment for patient care.
What might patient safety have to do with the joy and spirit of caregiving?
Editor’s note: Columnist Catherine Hinz, MHA, currently works at PatientSafe Solutions, Inc. Previously, she served as the patient lead at HealthEast Care System in St. Paul, MN, worked for seven years as an ED health unit coordinator, and has completed a patient safety internship with the Agency for Healthcare Research and Quality. The following is an excerpt from the October 2011 issue of Patient Safety Monitor Journal.
With the advent of electronic health record implementation, never-ending administrative duties, and unrelenting changes, it’s no surprise that practitioners often talk about losing the joy of caregiving. In fact, many patient safety and quality conferences have begun to focus on this theme. Practitioners often lament that medicine is becoming less of a “craft” and turning into a standardized methodology-sucking the joy out of caregiving and making the art of their practice obsolete. Of course, the other side argues that the need to minimize variation and practice pure, objective, evidence-based medicine should be the norm and not the exception.
This divide is especially acute when the conversation centers on clinical practice guidelines, order sets, protocols, and what some providers refer to as “cookbook medicine.” It can lead to a dynamic and sometimes dangerous discussion in any room with a mixed administrative and clinical audience.
At the recent National Quality Colloquium, one session focused on how physician engagement affects the organizational and patient safety culture. It became clear that given the immense changes under way in the U.S. healthcare system, and the need to reduce variation, eliminate waste, and improve quality, practitioners’ feelings of autonomy loss are bound to become more pronounced.
The discussion at NQC reminded me of a recent meeting in my own company. We had invited a group of nursing executives to engage in dialogue with us for a half day, discussing their challenges, needs, and hopes for their frontline staff and organizations. Beyond some of the typical things we expected to hear, like “we have scorecards coming out our ears” and “our systems are so complex, it makes any process improvement work daunting,” we heard something else loud and clear: “If you are going to bring any new technology into our environment, it should help put the spirit back in nursing.”
Log-in to read the full column in Patient Safety Monitor Journal.
Number of registrants for EHR incentives grow
Fourteen thousand providers have been collecting data required under the federal electronic healthrecord (EHR) program by using certified electronic health records for at least three months, reports Healthcare IT News. That number is up by a thousand since January, despite a new bill proposed by Rep. Jim Jordan (R-Ohio) that seeks to reduce federal spending by $2.5 trillion, singling out in part the $27 billion designated for incentives for EHR adoption.
The bill is unlikely to pass through the Senate, and President Obama would most likely veto it if it did. However, the bill has caused concern for some providers worried about the incentive program’s stability after the next presidential election.
Is your hospital adopting EHR in the hopes to gain incentives?
Leapfrog Group: CPOE systems should be monitored
I wrote up an article for HealthLeaders Media yesterday about a study released from The Leapfrog Group that shows that without thorough monitoring, computer physician order entry (CPOE) systems could potentially miss as many as one in three medication errors. The Leapfrog Group performed a simulation test using a web-based tool to test how often CPOE systems without modification could create potential adverse events.
You can read the full story by clicking here.
I’m curious about your hospital–CPOE is becoming pervasive and for good reason. CPOE can, when used correctly, prevent many medication errors from occurring. Has your hospital kept track of any potential problems or actual errors that have happened while using the system? Have you found that CPOE has made day-to-day responsibilities easier?
Electronic medical record goals are unrealistic, many physicians and hospitals say
Feedback from some of the nation’s most advanced hospitals indicates that many facilities will not be able to meet the government’s “meaningful use” requirements in relation to electronic medical records (EMR), reports The New York Times. “Meaningful use” refers to a set of requirements regarding EMRs that hospitals and physicians must meet to receive incentive payments through Medicare and Medicaid.
Physicians at these institutions, some of which have had EMRs instituted for years, say that the government’s requirements are difficult to meet and may in fact discourage users from attempting to achieve “meaningful use” because there is no reimbursement for partial credit. The advanced requirements have been put in place to meet a strict deadline set by President Barack Obama, and by 2015, hospitals and physicians will be penalized if they do not use EMRs.
To read more from The New York Times, click here.
What is the buzz at your facility about “meaningful use?” Are you meeting it? Is your hospital even trying to meet it?
AHA report says many hospitals will face fines for not complying with “meaningful use” in relation to EMRs
As part of legislation passed in 2009, all hospitals must be achieving “meaningful use” by 2015, or they may face penalties from the government. Meaningful use is a phrase that refers to the requirement that hospitals be “meaningful users” of health information technology.
To accomplish this, there are several aspects of an electronic medical record (EMR) for which hospitals are responsible for implementing. Medicare is providing incentive payments between fiscal years 2011 and 2016 for those facilities that do meet the requirements of meaningful use.
However, a new TrendWatch report, released recently by the American Hospital Association (AHA), shows that many hospitals will not be able to meet the requirements for meaningful use by 2015. In fact more than half of facilities surveyed earlier this year by the AHA say they will not be able to meet the current meaningful use requirements, which were released in a proposed rule in January 13, 2010.
Even if facilities want to take advantage of the quality improvement opportunities that EMRs afford hospitals (reducing adverse events, improving patient flow, reducing the number of hospital readmissions), they will be unable to do so because of the time requirements, resources necessary, and strict definitions in place in the current proposed meaningful use rule, says the report.
You can download the full report here. Do you think your facility will be able to meet the meaningful use requirement as it stands now? Do you stand to incur a penalty?
NEJM Perspective: EHR’s biggest benefit will be minimizing diagnostic errors
As the United States ramps up its adoption of electronic health records (EHR) and all of the health information technology that accompanies EHRs one of the largest benefits will be the minimization of diagnosis errors, according to a recent “Perspective” published in the New England Journal of Medicine (NEJM) . The authors, Gordon D. Schiff, MD, and David W. Bates, MD, assert that electronic documentation, when redesigned appropriately, will ultimately benefit the patient and physician by helping the physician rule out numerous diagnoses, as well as stay current with the stifling amount of medical education and advances that are available to caregivers.
The authors outline seven ways in which EHRs will reduce rates of diagnosis error.
- Filtering and organizing information that might help the physician make a better diagnosis
- Serving as a place where physicians can document their diagnoses, including possibilities of other potential diagnoses and thoughts on a patient’s illness
- Facilitating ongoing assessment and documentation of a patient’s primary diagnosis, including the allowance of multiple physicians and specialists to comment in one space
- Allowing for the easier creation of physicians’ ‘problem lists’
- Ensuring accurate communication between providers, as well as test ordering and result tracking
- Incorporating checklists more often into their interfaces, to prompt physicians with questions that could help in diagnosis
- Taking a stronger role in managing the follow-up visits with patients.
I’ve posted about diagnosis error in the past, and have been educated somewhat on how big of a problem it actually is. It’s not as easy for hospitals to get their proverbial hands around an issue like diagnosis error as it is preventing patient falls, or something of that nature, but it is an important one for the medical community to address. If EHRs are going to be as fully integrated into patient care as they are supposed to be within the next ten years, hopefully some or most of these authors’ thoughts about preventing diagnosis error will also be reality.
New and different challenges emerge between patient and physician with Internet advances
A recent commentary in the New England Journal of Medicine summarizes well the problems and benefits that the Internet has brought to American healthcare. Written by Pamela Hartzband, MD, and Jerome Groopman, MD, the commentary describe the Internet as the technological advance that has had the most profound effect on their clinical practices since they have been physicians. Because of its ability to provide vast amounts of true and misinformation, the Internet has given patients the ability to inform themselves about potential sicknesses for the better or for the worse. Hospitals have used the Internet to connect with patients more often and more efficiently; this too can have negative and positive consequences.
From a patient safety standpoint, I think learning how to harness the power of the Internet and all of the information contained on it is going to be one of the major challenges in the next ten years. Also, physicians and healthcare organizations will have to decide how they themselves view the Internet and want to interact with it. If patients cannot decipher what is true and what is false, is it physician’s responsibility to inform them? Perhaps this will become the job of a care manager- to act as a liaison to the patient and also keep in touch with physicians and caregivers about the information patients are seeking.
How do you view the Internet in conjunction with patient care? Is it a hinderance or an opportunity for improved care?
