The surging amount of information held by all the systems that contain patient data is increasingly being recognized as a safety concern, and healthcare organizations are looking for ways to lessen the risk by taking a holistic approach to health IT safety.

A variety of recent research has noted that information technology touches all aspects of care, involving not just classic clinical information systems, but registration, scheduling, billing, pharmacy and others that impact patient safety.

The ECRI Institute recently ranked information management in electronic health records as the top patient safety concern for healthcare organizations when it listed the top 10 patient safety concerns for 2017.

“The concerns with information management are very real and can have a devastating impact on care,” according to Lorraine Possanza, director of the ECRI Institute’s Partnership for Health IT Patient Safety Program. “Providers are deluged with information overload, yet still they need precise, timely and accurate information to provide care.”

Clinicians at Houston Methodist Hospital review their patients’ Rothman Index scores.
Clinicians at Houston Methodist Hospital review their patients’ Rothman Index scores.

For example, an error between computerized provider order entry and the pharmacy inventory management system can cause a different medication to be dispensed than what was prescribed by a physician. However, the ordering doctor may not have any indication that something is wrong and—unless the pharmacist accesses and reviews the patient’s medical record and finds that a medication was clearly not indicated for the patient—they also would not know better.

Problems arise when information sharing between systems affects patient care decisions, the experts say.

“When lab systems and EHRs do not share information because of interoperability issues; when providers must stop and click on a lab report in order to make certain that their choice for the appropriate antibiotic clearly identifies the infecting organism and the antibiotic with the highest sensitivity because looking at the report populated in the record skews the information (usability) before it is completely open; or when limiting those that can view certain parts of the record (access) prohibiting them from having the information needed for decision-making all can have serious safety consequences,” Possanza adds.

Also See: 10 top patient safety concerns in 2017

Proper information management in EHRs ensures that clinicians and other healthcare staff have the right information when and where they need it, while maintaining the highest standards for data integrity.

“Healthcare providers have troves of information to manage, and the advent of electronic health records has brought this challenge to the forefront,” states the 2017 ECRI report. “One key step is integrating health information management professionals, IT professionals and clinical engineers into patient safety, quality and risk management programs.”

Another strategy recommended by ECRI is “ensuring that users understand the system’s capabilities and potential problems, encouraging users to report concerns and investigating those concerns, engaging patients in information management, and harnessing the power of EHRs to enhance patient safety.”

When it comes to information management in EHRs and its top status as a patient safety concern, Andrew Gettinger, MD, chief medical information officer in the Office of the National Coordinator for Health IT, agrees with ECRI’s assessment.

“They’re not the only ones that have called for folks to pay attention to that,” says Gettinger, who is also executive director of the Office of Clinical Quality and Safety for ONC.

Toward that end, he notes that the agency recently updated its Health IT Playbook and Safety Assurance Factors for EHR Resilience (SAFER) guides to help providers assess the safety and usability of their respective EHRs.

“Recognizing, discussing and addressing these issues is the only way that we can make healthcare safer,” says Possanza. “Looking at the issues holistically and involving the elements of the socio-technical model which incorporates all stakeholders—vendors, providers, IT, human factor experts, patients and others—allows for everyone to work together to make healthcare safer.”

“We are seeing a major shift in healthcare delivery organizations to data-driven management. This is both on the frontlines of care for managing individual patients and at the organizational level for managing population health,” says Julia Adler-Milstein, an expert on health IT policy and management issues and associate professor in the School of Information at the University of Michigan.

However, according to Adler-Milstein, most healthcare organizations are struggling because they’ve been inundated with a tsunami of data almost overnight.

“We are seeing the need for ‘catch up’ in terms of the people and processes within organizations that are needed for effective data-driven management,” she adds. “And, it’s the people and processes that tend to be the hardest part.”

Both providers and support staff in healthcare organizations are the ones responsible for capturing patient data. The process includes a host of activities performed by staff to generate the desired results during patient visits, such as updating their contact information or documenting vital signs.

“Health IT involves looking at every aspect of the issue, not just one element,” Possanza says. “Today, technology touches every element of patient care, including not only the care itself but also what we commonly think of—documentation of the care.”

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