Wednesday, June 18, 2008

Supporting Quality with Information Technology

Next week, I'm meeting with the BIDMC Board's Patient Care Assessment and Quality Committee (PCAC) to discuss the 2009 tactics for improving quality with information technology. The overall presentation includes 2008 accomplishments, 2009 goals, the national context, and our general approach. I've chosen to communicate the specifics in the context of the Joint Commission's 2008 Patient Safety Goals. Those goals and our projects are below:

Goal 1 Improve the accuracy of patient identification.
1A Use at least two patient identifiers when providing care, treatment or services.
IS Projects: Positive Patient ID now deployed to all inpatients, ED patients, ambulatory surgery patients

Goal 2 Improve the effectiveness of communication among caregivers.
2A For verbal or telephone orders or for telephonic reporting of critical test results, verify the complete order or test result by having the person receiving the information record and "read-back" the complete order or test result.
IS Projects: Live with provider order entry in all locations except NICU and ED, which are 2009 projects

2B Standardize a list of abbreviations, acronyms, symbols, and dose designations that are not to be used throughout the organization.
IS Projects: Library Services and HIM have produced this list and widely circulated it

2C Measure and assess, and if appropriate, take action to improve the timeliness of reporting, and the timeliness of receipt by the responsible licensed caregiver, of critical test results and values.
IS Projects: Live with Results notification

2E Implement a standardized approach to “hand off” communications, including an opportunity to ask and respond to questions.
IS Projects: Discharge summary push live, enhancements to team census and discharge in 2009

Goal 3 Improve the safety of using medications.
3C Identify and, at a minimum, annually review a list of look-alike/sound-alike drugs used by the organization, and take action to prevent errors involving the interchange of these drugs.
IS Projects: Decision support databases for medication safety are updated monthly

3D Label all medications, medication containers (for example, syringes, medicine cups, basins), or other solutions on and off the sterile field.
IS Projects: Positive ID of medications with bar codes complete for 90% of medications

3E Reduce the likelihood of patient harm associated with the use of anticoagulation therapy.
IS Projects: POE supports evidence-based ordering of Heparin and standard dosing for warfarin, with latest relevant laboratory values.
Web OMR flow sheet supports tracking of INR values over time and from multiple sites.

Goal 7 Reduce the risk of health care-associated infections.
7A Comply with current World Health Organization (WHO) Hand Hygiene Guidelines or Centers for Disease Control and Prevention (CDC) hand hygiene guidelines.
IS Projects: Desktop screensaver about hand washing is live

7B Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a health care-associated infection.
IS Projects: Incident reporting and Adverse event reporting applications are live

Goal 8 Accurately and completely reconcile medications across the continuum of care.
8A There is a process for comparing the patient’s current medications with those ordered for the patient while under the care of the organization.
IS Projects: WebOMR medication list has become designated source of truth regarding patient’s medications and is used across all specialties. It is now in pilot for integration with inpatient history and med reconciliation and POE ordering

8B A complete list of the patient’s medications is communicated to the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization. The complete list of medications is also provided to the patient on discharge from the facility.
IS Projects: Within BIDMC, WebOMR medication list is used by all. Outside BIDMC MA-Share push pilot sends an electronic list of discharge medications to the next provider of care. Our e-Prescribing infrastructure includes a lifetime medication history from retail pharmacies and payers

Goal 9 Reduce the risk of patient harm resulting from falls.
9B Implement a fall reduction program including an evaluation of the effectiveness of the program.
IS Projects: Electronic nursing Kardex includes risk factor capture and calculation of Morse Score for patient’s risk of fall. Elevated scores trigger RN to request MD get a physical therapy consult. Fall risk is also available on unit dashboard (the graphic above)

Goal 13 Encourage patients’ active involvement in their own care as a patient safety strategy.
13A Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so.
IS Projects: Patients can access their entire health record via Patientsite, Google Health or Microsoft Healthvault

Goal 15 The organization identifies safety risks inherent in its patient population.
15A The organization identifies patients at risk for suicide.
IS Projects: Decision support databases are available for data analysis of diagnoses, labs, medications, radiology, pathology, and microbiology

Goal 16 Improve recognition and response to changes in a patient’s condition.
16A The organization selects a suitable method that enables health care staff members to directly request additional assistance from a specially trained individual(s) when the patient’s condition appears to be worsening.
IS Projects: New ICU system supports triggers and decision support based on clinical rules.

I'll also include a discussion of governance so that all understand how the stakeholders, including the Board, set the priorities for the work we do.


The Krafty Librarian said...

Hi John,
I just have one little point to mention on Goal 13.

"Encourage patients’ active involvement in their own care as a patient safety strategy.
13A Define and communicate the means for patients and their families to report concerns about safety and encourage them to do so.
IS Projects: Patients can access their entire health record via Patientsite, Google Health or Microsoft Healthvault"

It is great that patients will have access to their record but it doesn't mean that the will know what everything means within their own record. Lab tests and values as well as various diagnoses are often confusing to patients in the raw form. In addition to making the PHR available through one of those vendors, hospital IT departments, librarians, consumer health professionals, etc. need to look at providing or linking to supplemental patient education info that will help patients understand the things in their medical record.

If that information is not there or easily available within the record, patients are just simply going to ask Dr. Google for information which may make them more actively involved but may not help with patient health or safety.

John Halamka said...

You're completely correct. Personal Health Records are only useful if they are linked to great consumer information. For the BIDMC PHR, we offer access to UptoDate Consumer content. Google has provided drug monographs, disease monographs and decision support created by all for consumers.