Preventing Risk to Patient Safety when Implementing Health IT

By Larry Ozeran MD, President, Clinical Informatics Inc.

HIMSS’ core objective as an organization is to improve healthcare quality and patient safety through the best use of IT and management systems. As hospitals and providers work to implement electronic health records and other IT and management systems, HIMSS is launching a blog series on health IT and patient safety to help providers and hospitals identify potential risks to patient safety that have resulted from problems with EHR implementations and mitigate those risks through proactive measures.

Why should we promote patient safety?

We are starting with this question for several reasons.

1) This series will be looking at issues that many of us feel have obvious answers, but what is obvious is either wrong, or not as obvious to some as it is to others.

2) We will always begin by focusing on a goal.

3) It is important to reflect on our different motivators (ethics, finance, professionalism, compassion, diligence, etc.) and how they sometimes conflict.

I encourage you to take 10 minutes to think about this question. What does it mean to you? How do you answer it? There are many possible answers. Here are a few:

  • It is the [right|moral|ethical] thing to do.
  • It costs less (overall) than the alternative.
  • Because we can.
  • When I am a patient, I will want my providers to promote my safety.

This list is not intended to be comprehensive, only to stimulate your thoughts. You can undoubtedly think of many other reasons. This series is intended to promote some level of interactivity. If you have other answers to add, please email them to Jonathan French, HIMSS Director of Healthcare Information Systems.

As we begin this journey together, to identify safety risks and mitigation strategies, we should begin with some definitions, connotations and conventions.

In the ideal world, patients would get care and never suffer a complication. When their body wore out, they would die comfortably at home surrounded by family and friends. In our world, we have many areas which could be improved before we can realize such an ideal. Granted, there are many factors over which we either have no control, or the cost to implement a solution is so high as to be unaffordable. In this context, we must first define “risk,” “risk reduction,” and “risk avoidance.” This is starting to sound like traditional risk management, and it is, though we will apply an IT spin.

Risk – when referenced in our domain, risk is the possibility that a patient will suffer due to an error made by a member of the healthcare team.

Risk reduction – one or more cost-effective, reasonable steps that we can take to reduce the risk of patient harm. We will see that we prioritize these efforts along two distinct axes, according to those actions which reduce the risk of greatest patient harm (e.g. death and disability) and those actions which are the most cost-effective.

Risk avoidance – cost-effective measures that can completely eliminate risks. These are truly rare; risks that are infinitesimally small or where the cost to avoid them is unreasonably high, would not fit in this category.

IT plays a role in risk reduction and avoidance in many areas of healthcare and in many ways. Over time we will explore these in some detail. Some of these health IT related risks are obvious:

  • Software / development errors (vendor induced)
  • Operational / process errors (organization induced)
  • Implementation errors (organization induced)
  • User errors (organization and individual induced jointly)

Some of the health IT related risks are less obvious:

  • Failure to set SMART goals
  • Communication breakdown
  • Workflow disruption
  • Workarounds

What are some of your experiences with implementing health IT to ensure patient safety? If you were advising a facility that is just starting to implement, what lessons learned would you share that would prevent risks to the safety of your patients?

*Next week, we will discuss setting SMART goals for safely implementing health IT.

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