Safe EHR Adoption in Rural Hospitals and Clinics
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1 Safe EHR Adoption in Rural Hospitals and Clinics April 12, 2016 WANDA KELLEY, MSN, RN-BC INFORMATICS CLINICAL ADVISOR, WIDE RIVER, LLC Supporting the Healthcare Foundations of Our Communities Excellence Trust Community Objectives Participants will learn the state of electronic health record (EHR) diffusion across rural hospitals and clinics Participants will learn the sociotechnical issues that affect safe EHR adoption in rural hospitals and clinics Participants will learn strategies to improve safe EHR adoption in rural hospitals and clinics 2 Agenda Rural Health IT Snapshot Health IT Unintended Consequences Health IT Improvement Strategies Socio-Technical Model for Health IT Safety Assurance Factors for EHR Resilience (SAFER) Guides 3 1
2 Rural Health IT Snapshot 4 Rural Community Fast Facts Nearly 60,000,000 Americans 1,855 Rural Community Hospitals > 4,000 Rural Health Clinics 5 HITECH Act (2009) Provision of Regional Extension Centers (RECs) Certification of electronic health records (EHRs) Creation of Meaningful Use (MU) standards 6 2
3 Meaningful Use of Certified EHR Stage 1 (2011) Stage 2 (2014) Stage 3 (2018) Data capture and sharing Advanced clinical processes Improved outcomes 7 Hospitals, By Type, that Possess Certified EHR (2014) dashboard.healthit.gov/quickstats/pages/certified-electronic-health-record-technology-in-hospitals.php 8 Hospitals, By Type, that Possess Certified EHR (2014) dashboard.healthit.gov/quickstats/pages/certified-electronic-health-record-technology-in-hospitals.php 9 3
4 Hospital Progress to Meaningful Use of Certified EHR (2015) dashboard.healthit.gov/quickstats/pages/fig-hospital-progress-to-meaningful-use-by-size-practice-setting-area-type.php 10 Hospital Progress to Meaningful Use of Certified EHR (2015) dashboard.healthit.gov/quickstats/pages/fig-hospital-progress-to-meaningful-use-by-size-practice-setting-area-type.php 11 Provider Progress to Meaningful Use of Certified EHR (2016) dashboard.healthit.gov/quickstats/pages/fig-rec-providers-live-mu-practice-type.php 12 4
5 Provider Progress to Meaningful Use of Certified EHR (2016) dashboard.healthit.gov/quickstats/pages/fig-rec-providers-live-mu-practice-type.php 13 Challenges for Rural Health IT Insufficient capital Lack of knowledge about best practices Prohibitive start-up costs Costs of ongoing maintenance and support Loss of productivity and revenue caused by implementation Lack of technical expertise Unrealistic expectations regarding the implementation process Privacy concerns Changes in work processes and habits 14 Health IT Unintended Consequences 15 5
6 EHR-Related Etiologies Across Settings System-related issues Clinic 47% Hospital 55% User-related issues Clinic 62% Hospital 52% 16 System-Related Issues Clinic Hospital System and software design 14% 16% Routing of electronic data 7% 13% System dysfunction or malfunction 6% 10% Integration problems; incompatible systems 6% 5% Lack of or failure of EHR alert/alarm/decision support 5% 6% Fragmented information 5% 3% All other 2% 2% Totals may exceed 100% as multiple factors may be scored in any one case doi: /PTS User-Related Issues Clinic Hospital User Errors miscellaneous 21% 13% Hybrid health records/ehr conversion issues 18% 9% Incorrect information 12% 13% Pre-populating/copy & paste 10% 5% Training and education 5% 4% All other 1% 6% Totals may exceed 100% as multiple factors may be scored in any one case doi: /PTS
7 Health IT Improvement Strategies 19 Health IT Safety Journey 20 Socio-Technical Model for Health IT Measureme nt and monitoring Hardwar e and software Clinical content External rules and regulations Health IT Human computer interface Internal organizat ional features Workflow and communic ation People
8 SAFER Guides Foundational Guides High Priority Practices Organizational Responsibilities Infrastructure Guides Contingency Planning System Configuration System Interfaces Clinical Process Guides Patient Identification Computerized Provider order Entry with Decision Support Test Results Reporting and Follow-Up Clinician Communication 22 SAFER Phases and Principles Phase 1 Safe Health IT Address Safety Concerns Unique to EHR Technology Data Availability Data Quality and Integrity Data Confidentiality Phase 2 Using Health IT Safely Optimize the Safe Use of EHR Complete/Correct EHR Use EHR System Usability Phase 3 Monitoring Safety Use EHRs to Monitor and Improve Patient Safety Safety Surveillance, Optimization, and Reporting 23 SAFER Guide Clinician Communication 24 8
9 Where to Start? Raise awareness about impact of Health IT on patient safety Determine if your organization has a Health IT safety program Embrace EHR as part of risk and patient safety programs Provide system-wide awareness and education Internal IT and clinician collaboration Vendor, IT and clinician collaboration Bring a multidisciplinary team together to review the SAFER guides 25 Questions? 26 Resources Agency for Healthcare Research and Quality (AHRQ). (2016). Retrieved from American Hospital Association. (2016). Fast Facts on U.S. Hospitals [Fact Sheet]. Retrieved from Centers for Medicare and Medicaid Services. Rural Health Clinic. Baltimore, MD: U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, Medicare Learning Network; August, Rural Health Fact Sheet Series. Gale J.A., Croll Z., Hartley D, (2014). Adoption and Use of Electronic Health Records by Rural Health Clinics: Results of a National Survey. Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center; September, Working Paper #58. Graber ML, Siegal D, Riah H, Johnston D, and Kenyon K. Electronic Health Record-Related Events in Medical Malpractice Claims. J Patient Saf Nov 6. [Epub ahead of print] doi: /PTS HIMSS16 Conference Proceedings. HIT Safety Lessons Learned February 29, 2016 Dana Siegal RN, CPHRM, Director of Patient Safety, CRICO Strategies of the Harvard Medical Community IOM (Institute of Medicine) To Err Is Human: Building a Safer Health System. Washington, D.C.: National Academies Press. Office of the National Coordinator for Health Information Technology. 'Hospital Progress to Meaningful Use by Size, Type, and Urban/Rural Location,' Health IT Quick-Stat #5. dashboard.healthit.gov/quickstats/pages/fig-hospital-progress-to-meaningful-use-by-size-practice-setting-area-type.php. March Office of the National Coordinator for Health Information Technology. 'Percent of Hospitals, By Type, that Possess Certified Health IT,' Health IT Quick-Stat #52. dashboard.healthit.gov/quickstats/pages/certified-electronic-health-record-technology-in-hospitals.php. January Office of the National Coordinator for Health Information Technology. 'Percent of REC Enrolled Providers by Practice Type Live on an EHR and Demonstrating Meaningful Use,' Health IT Quick-Stat #37. dashboard.healthit.gov/quickstats/pages/fig-rec-providers-live-mu-practice-type.php. January Rouse, W.B Health care as a complex adaptive system: Implications for design and management. The Bridge Linking Engineering and Society, 38(1) Retrieved from Sittig, D. F., & Singh, H. (2010). A New Socio-technical Model for Studying Health Information Technology in Complex Adaptive Healthcare Systems.Quality & Safety in Health Care, 19(Suppl 3), i68 i
10 Wide River Contact Information Follow us on Excellence Trust Community 28 10
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