Chris Longhurst at BayCHI: Unintended Consequences of Healthcare IT
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Chris Longhurst at BayCHI: Unintended Consequences of Healthcare IT

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Chris Longhurst at BayCHI: Unintended Consequences of Healthcare IT Chris Longhurst at BayCHI: Unintended Consequences of Healthcare IT Presentation Transcript

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  • ([DPSOH /3&+ 1,&8 Unique Adverse Events per Patient Adjusted by Birth Weight 1.6 1.4 LPCH 1.2 1Rate 0.8 0.6 0.4 0.2 0 1 2 7 8 9 11 12 14 17 19 22 24 26 27 28 Hospital ID Unique AE Rate Unique AE Adj Rate
  • ([DPSOH /3&+ :RUVH WKDQ FKDRV XQVWDEOH Culture of Safety Survey 2002 vs 2004 (Weighted Scores) 30P ercent P roblematic 24.7 24.26 25 23.1 18.2 16.95 19.1 20 17.3 17.68 15.5 13.7 15 12.1 11.07 10 5 0 Management/Organization Individual Shame/Blame Overall Average Performance/Structure PSC 2002 LPCH 2002 LPCH 2004
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  • 1(-0“All practice errors can not be attributed to the humancauses of ignorance and avarice. Thus, I conclude thatthough the individual physician is not perfectable, thesystem of care is, and that the computer will play amajor part in the perfection of future care systems.”
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  • EMR Adoption Model (HIMSS 2007) Stage Cumulative Capabilities % of US hospitals Stage 7 Medical record fully electronic; CDO able to contribute to EHR as byproduct of 0.0% EMR Stage 6 MD Documentation (structured templates), full CDSS (variance and 0.8% compliance), full PACS Stage 5 Closed loop medication administration 1.4% Stage 4 CPOE, CDSS (clinical protocols) 2.2% Stage 3 Clinical documentation (flow sheets), CDSS (error checking), PACS available 25.1% outside of radiology Stage 2 Clinical data repository, Controlled Medical Vocabulary, Clinical Decision 37.2% Support System (CDSS) capability Stage 1 Ancillaries – Lab, Rad, Pharmacy 20.5% Stage 0 All three ancillaries NOT installed 19.3%Source: HIMSS Analystics™ Database © 2007. N=5,073
  • /3&+ ,QIRUPDWLRQ .QRZOHGJH 6VWHP /,1.6ƒ Cerner selected as LPCH partner for IT applications in 2002ƒ LINKS phase 1 went live in 2005 – results review, unit clerk order entry, pharmacy, radiology systems, etc.ƒ LINKS phase 2 went live in 2007 – CPOE / Clinical Documentation
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  • &32( DQG 9HUEDO 2UGHU DW /3&+ For the time period 11/5 – 12/31 (excluding the perinatal service line*) LPCH is averaging a 93% CPOE rate, and a 7% verbal order rate for the “live” areas.100% 98% 97% 97% 96% 96% 96% 96% 97% 96% 96% 96% 96% 96% 95% 95% 94% 94% 94% 94% 94% 94% 94% 94% 94% 93% 93% 93% 93% 93% 93% 92% 92% 92% 92% 92% 92% 92% 91% 92% 92% 92% 92% 91% 91%90% 90% 90% 90% 89% 90% 89% 89% 88% 88% 86% 85% 83% 81%80% % CPOE70%60%50%40%30%20% % Verbal 19% 17% 15% 14% 12% 12% 11% 11% 11%10% 10% 10% 9% 8% 9% 10% 10% 9% 8% 7% 8% 8% 8% 8% 8% 8% 8% 8% 8% 6% 6% 7% 7% 7% 7% 7% 6% 6% 6% 6% 5% 6% 6% 6% 4% 4% 5% 4% 4% 4% 3% 3% 4% 4% 4% 4% 3% 2% 0%* - obstetric areas allow the use of verbal orders per medical policy.
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  • EMR Adoption Model Stage Cumulative Capabilities % of US hospitalsStage 7 Medical record fully electronic; CDO able to contribute to EHR as byproduct of 0.0% EMRStage 6 MD Documentation (structured templates), full CDSS (variance and 1.0% compliance), full PACSStage 5 Closed loop medication administration 1.3%Stage 4 CPOE, CDSS (clinical protocols) 2.1%Stage 3 Clinical documentation (flow sheets), CDSS (error checking), PACS available 28.4% outside of radiologyStage 2 Clinical data repository, Controlled Medical Vocabulary, Clinical Decision 35.3% Support System (CDSS) capabilityStage 1 Ancillaries – Lab, Rad, Pharmacy 13.1%Stage 0 All three ancillaries NOT installed 18.9%Source: HIMSS Analystics™ Database © Q1 2008. N=5,073
  • 7KH /DZ RI 8QLQWHQGHG &RQVHTXHQFHVThe “Law of UnintendedConsequences” encapsulatesthe idea that almost all humanactions have at least oneunintended consequence,where an action results in anoutcome that is not (or notonly) what is intended.
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  • CPOE in a Children’s Hospital 8QH[SHFWHG,QFUHDVHG 0RUWDOLW THE INFORMED PATIENT By LAURA LANDRO $IWHU Tech Glitches Can Slow Patient,PSOHPHQWDWLRQ RI D Care &RPPHUFLDOO 6ROG New Computers May Deliver Turmoil When They Arrive; &RPSXWHUL]HG One Study Cites Death Rates 3KVLFLDQ 2UGHU December 28, 2005; Page D6 (QWU 6VWHP A controversial study linking an increased death rate to the installation of a new computerYong Y. Han, et al. Pediatrics 2005; 116; 1506-1512 system at Childrens Hospital of Pittsburgh reinforces growing…
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  • &RQVHTXHQFHV RI +HDOWKFDUH ,7 Anticipated UnanticipatedDesirable Undesirable Desirable Undesirable Goals Trade-offs Serendipity Today’s topic Direct Indirect Manage Acknowledge
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  • 8$& 8QIDYRUDEOH :RUNIORZ ,VVXHVƒ Problem ƒ Modeling clinical workflows is difficult because clinical practice is so inherently complex, interruption-driven, and constantly changing.ƒ 5HFRPPHQGDWLRQ ƒ Recognize that no EMR system fits all workflows of a given hospital perfectly. Even if a system initially did so, it would not eliminate the need for constant system adaptation to changing workflows in the future. ƒ Realize that whenever there are adjustments, there will be unintended consequences.
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  • 8$& 1HYHU (QGLQJ 6VWHPHPDQGVƒ Problem ƒ EMR systems evolve (i.e., are reconfigured, enhanced, or replaced) over time, making hardware and software upgrades a necessity. As changes occur, users must be retrained and quality assurance measures must be reassessed.ƒ 5HFRPPHQGDWLRQ ƒ With each change, implementers should expect unintended consequences. Although these consequences can be anticipated, their extent is typically underestimated. ƒ Adequate resources must be allocated for these ongoing improvements!
  • 8$& 1HYHU (QGLQJ 6VWHPHPDQGV“EMR maintenance is likerepairing a jet engine in flightbecause the consequences ofmaking mistakes are ordersof magnitude greater than forless-integrated clinicalsystems.”
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