optimizing emr workflow to reduce medical errors & physician frustration

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 proprietaryinformation of The Sullivan Group. Unauthorized use, copying or dissemination of these materials is strictly prohibited.

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2RSQ® Solutions

PresenterDan 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).

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3RSQ® Solutions

PresenterDan 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.

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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.

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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

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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.

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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.

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American Health Information Management Association (AHIMA)

according to a September AHIMA report. http://www.healthcareitnews.com/news/ehr-copy-paste-better-think-twice

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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."

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Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy (2013)

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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.

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Meaningful Use Definition & ObjectivesMeaningful Use DefinedMeaningful 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

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Leading Causes of Death in U.S.

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Used with permission from and art by Caroline Laplante http://claplante.blogspot.ca/

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A PromiseUnfulfilled

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Time For AChange!!

A PromiseUnfulfilled

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Human Factors Engineering

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Vital Signs Re-EvaluationNational 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.

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Vital Signs Re-EvaluationNational 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.

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Vital Signs Re-EvaluationNational 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.

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32RSQ® Solutions

Vital Signs Re-EvaluationNational 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.

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Data from CRICO-2011 EM Analysis

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Data from CRICO-2011 EM Analysis

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Data from CRICO-2011 EM Analysis

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Data from CRICO-2011 EM Analysis

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Vital Sign Solution

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Vital Sign Solution

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Vital Sign Solution

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Extremity Lacerations

What do we miss? Vascular injury Neurologic injury Tendon injury

Why? Because we are human!

The solution?

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The HPI Must Talk to the Review of Systems

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The Entire Medical Record Should Talk to Medical Decision Making

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The HPI and PE Should Talk to Medical Decision Making

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HR = 120

POx = 92%

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Nurse Enters Birth Weight on an Infant

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If the child is less than 60 days of age, the program asks for a current weight

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Neonatal Auto Weight Calculator with Alerts

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Neonatal Auto Weight Calculator with Alerts

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Neonatal Auto Weight Calculator Alert

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Syndrome Surveillance

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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)

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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!

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76RSQ® 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.

Thank You