No Quick Fix

Patient safety can be jeopardized if providers expect electronic medical records to fix broken – or nonexistent – processes

You know what they say about fire: Carefully controlled, it’s a lifesaver; out of control, it’s a killer. Same with water. (Think of floods and tsunamis.) But electronic health records?

Yes, the electronic health record heralded not only as a potential cost-saver, but as an increasingly necessary tool for better patient care – comes with some risks of its own. They can, of course, be controlled. But doing so takes time, attention, diligence and leadership. With the promise of $30 billion in federal stimulus money in the offing, some experts want to make sure hospitals don’t jump in to EHR without providing the necessary attention to it. One of them is The Joint Commission.

In March, Joint Commission Resources – a nonprofit affiliate of The Joint Commission – announced the launch of a new consulting service intended to provide an expert evaluation of technology, and work with hospitals to address patient safety gaps. The service is called Safe Adoption of Technology.

The issue
“Fewer than 10 percent of healthcare organizations have a fully functioning electronic health record,” says Nanne Finis, executive director, Solutions Consulting, Joint Commission Resources. “But that number will surge in the next couple of years. We’re calling on providers to plan, design and build with patient safety as a priority as they’re implementing health information technologies and other technologies – bar coding, smart pumps, etc.”

Its announcement in March wasn’t the first time Joint Commission has sounded the alarm about the potential ill effects of improper implementation of electronic medical records. In December 2008, the organization issued a sentinel event alert called “Safely implementing health information and converging technologies.” In it, Joint Commission cautioned users about potential adverse events associated with poor selection and implementation of electronic medical records.

“These adverse events typically stem from human-technology interfaces or organization/system design,” according to the organization. “The overall safety and effectiveness of technology in health care ultimately depend on its human users, ideally working in close concert with properly designed and installed electronic systems.”

Begins with the provider
In their haste to implement an electronic system, some providers are making critical errors, says Finis. “They may apply a technology solution to a broken process. This is a mistake. Processes that will be affected by technology implementation must be evaluated and often re-designed to ensure that the desired outcome is achieved safely, effectively, and efficiently.

“Successful implementation must begin with the organization’s key decision-makers examining current workflow processes and procedures, and figuring out how an electronic system can enhance it. And key decision-makers must be at the table during that analysis, including physicians, nurses, IT professionals, pharmacists, respiratory therapists and others.”

Together, they must develop policies and procedures as to who will oversee the electronic technology, who will manage ongoing enhancements and updates, and who will be responsible for monitoring its patient safety aspects. And they must make pertinent clinical decisions, such as, how far will the system go in trying to prevent a physician from prescribing a certain medication that could turn out to be harmful, given a patient’s medical history and condition, or other medications he or she is taking.

Indeed, medication errors are the No. 1 concern of many organizations, and it is where Joint Commission Resources will be focusing much of its attention, at least initially. “But we will expand that as time goes on,” says Finis. For example, JCR is considering how it can help providers adapt their systems to aid in infection prevention and control through the monitoring of patients who might be susceptible to infection.

“It’s really looking at the whole treatment process, from the time the patient is admitted into the system to post-discharge, including how they’re educated” about their condition, adds Jeannell Mansur, RPh, PharmD, FASHP, practice leader, medication safety, Joint Commission Resources.

Help in three areas
For now, Joint Commission Resources consultants will focus on helping hospitals with three aspects of electronic health records:

  • Planning and selection of an electronic system, including decisions about the functionality of a new system (What exactly does the hospital want it to do?), retiring or modifying the old system, creating an implementation timeline, and involving key stakeholders in the process.
  • Designing, building and implementing an electronic health record. Included is help with considering the impact of a new EMR on the organization, as well as safety enhancements and training needs.
  • Post-implementation. After implementation, how does the provider troubleshoot problems, create medication management checklists for staff, and implement other measures to make sure the system is doing what it’s supposed to.

Due diligence
Hospitals need to do their due diligence before selecting an EMR vendor. They can do site visits and try to nail down what kind of post-implementation support the vendor can offer. “And they need to have processes in place to monitor problems and address issues quickly,” says Finis.

“The successful and safe implementation of technology requires insightful and strategic leadership. It’s a culture change.”