On February 4, I attended the Massachusetts Health Data Consortium conference entitled HIT '11: The tools for meaningful and accountable care. It was a fabulous day packed with information from health care providers and health care payers across the nation.
Since I couldn't keep up with the information flow, I'm looking forward to reviewing the slides once they're up later this month. In the meantime, the next few posts provide snippets from several sessions.
I hope you'll find it as interesting as I did. This one focuses on the first session: Clinical Decision Support: Technology at the point of care.
The pluses and minuses of alerts during the prescribing process
Electronic Medical Records systems alert physicians when their prescriptions may conflict with best practice. Physicians then have the option of changing their orders-and overriding the alerts with an explanation of why they did so.
One problem is that if these systems provide too many false alarms, physicians just override all of them. Another problem is that overriding alerts can expose the physician to malpractice claims.
The goal is to provide useful information, without impeding work flow
Michael Lee, Director of Clinical Informatics at Atrius Health, spoke about the steps his physician group is taking to provide physicians with tools they can use, at the point of care, to avoid medical errors. Dr. Lee explained that one of his organization's goals is to strike the right balance between providing useful information-and impeding physicians' work flow.
Steps to success
Dr. Lee and his organization have addressed these concerns in a number of ways. For one, the organization asked clinicians which alerts were driving them crazy. Then, it formed a clinical panel to determine how important each alert is and which alerts the organization can suppress.
To ensure, however, that physicians have the information they require at the point of care, Dr. Lee has worked with Up-to-Date, a publisher of evidence-based guidelines, to incorporate a "quick reference button" . This button enables physicians to access Up-to-Date's content directly from the electronic medical record . As an incentive to consult this data, the organization provides physicians with Continuing Medical Education (CME) credit for the time they spend using Up-to-Date.
To expedite the work flow, the organization has also identified which decisions the physicians must make themselves. The support staff makes the remaining decisions. Future goals include decision support for high cost imaging services and involving patients more in their own care.
Automation of med delivery: From brain to vein
Next, Dr. Daniel Nigrin, the CIO at Childrens Hospital introduced us to the Childrens Hospital Applications for Maximizing Patient Safety (CHAMPS) using medication administration as an example. Here, the goal was to automate all aspects of the process "from brain to vein" and across multiple actors (i.e. physicians, pharmacists, nurses, technicians, and couriers).
Children have special needs
Dr. Nigrin, began by pointing out that children are at especially high risk for medication dosing errors. They are smaller than adults; and there is a wide spectrum of patients, from premature babies to 18-year-old football players. Because of this variation in patients, there are more than 1000 custom order sets, representing 70% of the total.
Better systems, in combination, reduce errors by 50%
The organization tracks the status and locations of the medication at each step of the process. Since Children's implemented this process, there has been a 50% reduction in medical errors.
It uses barcodes to ensure delivery of the right medication, location codes to help nurses keep track of where the medication is, and time stamps to find bottlenecks. The tool also provides alerts about doses that occur too often to prevent overdoses.
CPOE, alone, had a modest effect. It was the combination with bar coding, that enabled Childrens Hospital to sustain the decrease in medical errors.