Optimizing EMR Workflow to Reduce Medical Errors & Physician Frustration
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EHRs have an incredible opportunity to improve patient safety and reduce medical errors, but in their current state they are doing more to frustrate providers than improve care. Here we'll review ideas to optimize EHR workflow to improve patient safety and reduce physician frustration.
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Optimizing EMR Workflow to Reduce Medical Errors & Physician Frustration
- 1. Optimizing EMR Workflow to Reduce Medical Errors and Provider Frustration Dan Sullivan, MD, JD, FACEP Copyright © 1998 - 2016, The Sullivan Group, All Rights Reserved. These materials comprise the proprietary information of The Sullivan Group. Unauthorized use, copying or dissemination of these materials is strictly prohibited.
- 2. 2 RSQ® Solutions 2 RSQ® Solutions Presenter Dan Sullivan, MD, JD, FACEP Dr. Sullivan is the President and CEO of The Sullivan Group, a leader in risk management, patient safety and quality improvement solutions for healthcare providers. Dr. Sullivan is a board certified Emergency Medicine physician and a Fellow in the American College of Emergency Physicians (ACEP).
- 3. 3 RSQ® Solutions 3 RSQ® Solutions Presenter Dan Sullivan, MD, JD, FACEP Dr. Sullivan is an expert in building risk management, patient safety, and evidence-based medicine seamlessly inside of electronic medical records. The Sullivan Group’s EMR Risk Management Module is currently in place in over 500 U.S. hospitals.
- 4. 4 RSQ® Solutions 4 RSQ® Solutions Learning Objectives Create an awareness of the current “State of the Union” as it applies to patient safety and practitioner frustration when using EHR/EMRs Understand the impact of EHR technology on patient care. Share ideas on optimizing EMR/EHR workflow to improve safety and reduce practitioner frustration.
- 10. 10 RSQ® Solutions 10 RSQ® Solutions Allocation of Physician Time in Ambulatory Practice: A Time and Motion Study in 4 Specialties Allocation of Physician Time in Ambulatory Practice Ann Intern Med. Published online 6 September 2016 doi:10.7326/M16-0961 © 2016 American College of Physicians
- 11. 11 RSQ® Solutions 11 RSQ® Solutions Participants: 57 U.S. physicians in family medicine, internal medicine, cardiology, and orthopedics who were observed for 430 hours; 21 of them also completed after-hours diaries. Measurements: Proportions of time spent on 4 activities (direct clinical face time, electronic health record [EHR] and desk work, administrative tasks, and other tasks) and self-reported after-hours work.
- 12. 12 RSQ® Solutions 12 RSQ® Solutions Results: During the office day, physicians spent 27.0% of their total time on direct clinical face-time with patients and 49.2% of their time on EHR and desk work. The 21 physicians who completed after-hours diaries reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks.
- 13. 13 RSQ® Solutions 13 RSQ® Solutions American Health Information Management Association (AHIMA) according to a September AHIMA report. http://www.healthcareitnews.com/news/ehr-copy-paste-better-think-twice
- 14. 14 RSQ® Solutions 14 RSQ® Solutions It has become such a compliance and payment problem that the U.S. Department of Health and Human Services Secretary Kathleen Sebelius together with Attorney General Eric Holder wrote a letter last year to industry medical groups underscoring the seriousness of doctors "gaming the system, possibly to obtain payments to which they are not entitled."
- 15. 15 RSQ® Solutions 15 RSQ® Solutions Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy (2013)
- 17. 17 RSQ® Solutions 17 RSQ® Solutions Why was the HITECH Act Created? The Health Information Technology for Economic and Clinical Health Act (HITECH) legislation was created in 2009 to stimulate the adoption of electronic health records (EHR) and supporting technology in the United States.
- 19. 19 RSQ® Solutions 19 RSQ® Solutions Meaningful Use Definition & Objectives Meaningful Use Defined Meaningful use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities Engage patients and family Improve care coordination, and population and public health Maintain privacy and security of patient health information
- 21. 21 RSQ® Solutions 21 RSQ® Solutions Leading Causes of Death in U.S.
- 22. 22 RSQ® Solutions 22 RSQ® Solutions Used with permission from and art by Caroline Laplante http://claplante.blogspot.ca/
- 23. 23 RSQ® Solutions 23 RSQ® Solutions A Promise Unfulfilled
- 24. 24 RSQ® Solutions 24 RSQ® Solutions Time For A Change!! A Promise Unfulfilled
- 25. 25 RSQ® Solutions 25 RSQ® Solutions Human Factors Engineering
- 29. 29 RSQ® Solutions 29 RSQ® Solutions Vital Signs Re-Evaluation National Profile We looked at vital signs in 90,000 patients. 9,000 were very abnormal. 16% of patients with very abnormal vital signs are discharged without a single repeat. This is a common finding in failure to diagnose cases.
- 30. 30 RSQ® Solutions 30 RSQ® Solutions Vital Signs Re-Evaluation National Profile We looked at vital signs in 90,000 patients. 9,000 were very abnormal. 16% of patients with very abnormal vital signs are discharged without a single repeat. This is a common finding in failure to diagnose cases.
- 31. 31 RSQ® Solutions 31 RSQ® Solutions Vital Signs Re-Evaluation National Profile We looked at vital signs in 90,000 patients. 9,000 were very abnormal. 16% of patients with very abnormal vital signs are discharged without a single repeat. This is a common finding in failure to diagnose cases. cases.
- 32. 32 RSQ® Solutions 32 RSQ® Solutions Vital Signs Re-Evaluation National Profile We looked at vital signs in 90,000 patients. 9,000 were very abnormal. 16% of patients with very abnormal vital signs are discharged without a single repeat. This is a common finding in failure to diagnose cases.
- 34. 34 RSQ® Solutions 34 RSQ® Solutions Data from CRICO-2011 EM Analysis
- 35. 35 RSQ® Solutions 35 RSQ® Solutions Data from CRICO-2011 EM Analysis
- 36. 36 RSQ® Solutions 36 RSQ® Solutions Data from CRICO-2011 EM Analysis
- 37. 37 RSQ® Solutions 37 RSQ® Solutions Data from CRICO-2011 EM Analysis
- 39. 39 RSQ® Solutions 39 RSQ® Solutions Vital Sign Solution
- 40. 40 RSQ® Solutions 40 RSQ® Solutions Vital Sign Solution
- 41. 41 RSQ® Solutions 41 RSQ® Solutions Vital Sign Solution
- 42. 42 RSQ® Solutions 42 RSQ® Solutions Extremity Lacerations What do we miss? Vascular injury Neurologic injury Tendon injury Why? Because we are human! The solution?
- 49. 49 RSQ® Solutions 49 RSQ® Solutions The HPI Must Talk to the Review of Systems
- 51. 51 RSQ® Solutions 51 RSQ® Solutions The Entire Medical Record Should Talk to Medical Decision Making
- 52. 52 RSQ® Solutions 52 RSQ® Solutions The HPI and PE Should Talk to Medical Decision Making
- 61. 61 RSQ® Solutions 61 RSQ® Solutions HR = 120 POx = 92%
- 64. 64 RSQ® Solutions 64 RSQ® Solutions Nurse Enters Birth Weight on an Infant
- 65. 65 RSQ® Solutions 65 RSQ® Solutions If the child is less than 60 days of age, the program asks for a current weight
- 66. 66 RSQ® Solutions 66 RSQ® Solutions Neonatal Auto Weight Calculator with Alerts
- 67. 67 RSQ® Solutions 67 RSQ® Solutions Neonatal Auto Weight Calculator with Alerts
- 68. 68 RSQ® Solutions 68 RSQ® Solutions Neonatal Auto Weight Calculator Alert
- 70. 70 RSQ® Solutions 70 RSQ® Solutions Syndrome Surveillance
- 71. 71 RSQ® Solutions 71 RSQ® Solutions Kawasaki’s Syndrome History of fever from caregiver (HPI) Cervical adenopathy (PE neck) Mucous membrane changes: lips, tongue (PE HEENT) Changes in the peripheral extremities: swelling, desquamation (PE extremities) Rash on the trunk (PE skin)
- 75. 75 RSQ® Solutions 75 RSQ® Solutions Summary Human factors engineering is one of many opportunities to impact the practitioner/ patient experience. Correctly applied, it can improve quality and safety and reduce medical errors. Correctly applied, it can improve practitioner satisfaction and reduce frustration. It’s the future; let’s get there ASAP. It’s an exciting ride and the sky is the limit!
- 76. 76 RSQ® Solutions 76 RSQ® Solutions Questions? Please contact Brant Roth at broth@thesullivangroup.com for information about TSG’s RSQ® Solutions. Please contact your Bermuda brokers for more information about the XL Catlin-TSG partnership.
- 77. Thank You
Notes de l'éditeur
- “Thank you for joining us, today’s webinar topic is Improving Diagnosis Through Human Factors Engineering, presented by Dr. Dan Sullivan, President & CEO of The Sullivan Group, the leading provider of risk management, patient safety and quality improvement solutions for healthcare providers.”