New Self-Assessment Guides Help Ensure Safer Electronic Health Records Dean F. Sittig, PhD DISCLAIMER: The views and opinions expressed in this presentation are those of the author and do not necessarily represent official policy or position of HIMSS.
Conflict of Interest Disclosure Dean F. Sittig, PhD Has no real or apparent conflicts of interest to report. 2013 HIMSS
Learning Objectives Recognize the need for a multi-dimensional sociotechnical approach to EHR safety Identify and discuss high-risk, EHR-related, clinical work processes and assessment methods Respond to EHR-related safety risks within your EHR-enabled clinical work system. Assemble a multidisciplinary team to assess the safety of your organization's EHR-enabled clinical work system.
Quality & Safety in Healthcare, 2010 Oct;19 Suppl 3:i68 74
Safety in an EHR-enabled System Safety Concerns Unique to Technology Safety Concerns from Failure to Use Technology Appropriately Use Technology to Monitor and Improve Patient Safety Sittig & Singh NEJM Nov 8 2012
SAFER: Safety Assurance Factors for EHR Resilience Develop resources for proactive assessment of safety in the EHRbased clinical work system Funded through ONC: HHSP23337003T, Westat: HHSP23320095655WC0095655
Key Error-prone Processes Computer-based Provider Order Entry (CPOE) and e-prescribing Clinical Decision Support (CDS) Communication between settings Patient identification EHR system downtime events EHR customization & configuration System-system interface data transfer Health IT safety-related human skills
Principles Phase 1: Data availability: EHRs and their associated data are available to authorized individuals to support healthcare delivery and business operations. High Priority Practices Practices 1. All data are backed up and all mission critical hardware systems are duplicated. 2. All medications, allergies, problem list entries, and diagnostic test results (or interpretations of those results e.g., normal, abnormal), are stored using standard, coded data elements in the EHR. 3. Evidence based order sets and charting templates are available for common clinical conditions, tasks, services, and healthcare processes 4. Interactive clinical decision support features and functions (e.g., interruptive and passive suggestions or warnings) are available and functioning 8 appropriately to prevent common clinical errors.
Principles High Priority Practices Practices Phase 1: Data integrity: Data are accurate, consistent and not lost, altered or created inappropriately 5. All hardware and software (e.g., CPOE and CDS functionality) modifications are tested and all highpriority, clinical processes are simulated both preand post go live. 6. All applications and system system interfaces are tested to ensure that data are not lost, incorrectly entered, displayed, or transmitted within or between EHR system components. 7. All clinical content is reviewed on a regular basis and additionally as needed to ensure accuracy. 9
Principles Phase 2: System usability: features and functions required to manage the treatment, payment, and operations of the healthcare system must be designed, developed, and implemented to minimize the potential for errors. In addition all information in the system must be clearly visible, understandable and actionable to authorized users. High Priority Practices Practices 8. All information required to accurately identify the patient is clearly displayed on all screens and printouts. 9. All aspects of the human computer interface are visible, readable, understandable, and usable. 10. The status of user input actions are communicated rapidly in unambiguous language, fully acknowledged, and clearly visible to other users of the system. 11. Clinicians can override, but not permanently disable, any computer generated clinical intervention. 10
Principles High Priority Practices Practices Phase 2: Complete and correct EHR use: correct system usage (e.g., features and functions are used as designed, implemented, and tested) is required for all mission critical clinical processes throughout the organization 12. EHR/CPOE use is required for ordering all medications, diagnostic tests and procedures. 13. Adequate numbers of knowledgeable staff members are available to train, test, and provide support for all clinical EHR users to ensure complete EHR use. 14. Default settings have been established for common medication, laboratory, and radiology orders to reduce unnecessary variation in clinical practice. 11
Principles Phase 3: EHR related Safety Measurement and Improvement: Monitor all mission critical aspects of EHRs and healthcare processes. High Priority Practices Practices 15. A multi disciplinary decision making process, that includes clinicians, provides oversight and accountability for health information technology safety and addresses all EHR related system errors promptly. 16. Key EHR safety metrics are reported to those accountable for organizational performance (e.g., the organization s board of directors or physician leadership) on a regular basis. 17. Complete records of all EHR related patient safety hazards, along with the actions taken to remedy them, are maintained. 12
Thank You! Dean F. Sittig, PhD Dean.F.Sittig@uth.tmc.edu @DeanSittig