Achieving higher levels of patient safety and quality care validation are at the top of every healthcare provider’s list of goals, yet attaining them can take many different routes depending on the methodology and type of technology deployed, say the makers and users of various IT systems.
For instance, Jackson Health Network aimed to reduce gaps in care across its physician sites in south central Michigan. COO Wynn Hazen says Dallas-based Phytel has been a good fit for this mission because its Atmosphere platform integrates health data with a patient communication engine, combining analytic reports with interventional capabilities.
“It is a clinically integrated network that allows physicians and hospitals to improve outcomes and the experience of care while impacting the cost curve,” said Hazen, whose consortium of hospitals and physician practices serves approximately 160,000 in the greater Jackson area. “We are contracting with payers to create a new financing method to align how we pay for healthcare and get away from the fee-for-service mentality.”
Phytel chief medical officer Richard Hodach, MD, adds that the platform is designed to gather data from various provider systems, including billing, scheduling and electronic medical records and brings it into a patient-oriented registry.
“It uses a series of algorithms based on national guidelines and standards of care to create a series of reports used with that data,” he said. “Once you get these reports you can see a whole population, spot the care gaps and use the tools to reach out to these patients and effectively close these gaps.”
The drive to automate clinical functions as a patient safety measure has been escalating in recent years, notes Jean Broberg, director of site development for San Diego-based CliniComp.
“People want to go to the next level,” she said. “We are there to help them with their configuration needs, hardware upgrades and to make sure they have outstanding results.”
The ability to get data out to the back end is especially important, she said, “because in this mobile age, it has to be pushed out to where the doctors are.”
Texas Radiology Associates in North Dallas has been concentrating on patient safety as a “key to a successful practice” for decades, says radiologist Paul Staveteig, MD. The 70-physician radiology group, which includes 18 hospitals and a number of imaging centers, conducts a regular Process Quality Review in tandem with the American College of Radiology’s online peer review process.
The six-member panel randomly selects cases anonymously from a national database and evaluates whether the decision-making was correct in each case. Advancements in IT have made the peer review process much more thorough and expedient, Staveteig said.
“Today we have a rapid turnaround of radiology reports – in the old days they had to be transcribed and weren’t available until 36 hours later…now it is within 30 minutes,” he said. “If a report is not timely, it is not useful. So we make them useful by making them timely.”
Another patient safety strategy is using instruction to get physicians thinking differently about how they do things. That is the intent of Decision Simulation, a screen-based program geared for clinical education, says J.B. McGee, MD, assistant dean for medical education technology at the University of Pittsburgh School of Medicine.
“This is the ideal way to train physicians in continuing education since it uses scenarios of treating actual patients,” said McGee, who also serves as scientific advisory board chairman for the Chadds Ford, PA-based manufacturer. “It gets us in a different way of thinking. When you see the onscreen patient get better because of a decision you made, that leads to changing your behavior in the real world.”
Electronic product surveillance also provides an extra measure of patient safety by giving the clinical staff precise information about the location and status of lifesaving devices, says Merrie Wallace, RN, chief of nursing and executive vice president of product solutions for San Diego-based Awarepoint. By using a GPS type of locator, clinical staff not only find essential products, they can also track the flow of these products to ensure they have been properly decontaminated.
“It enables staff to chart the flow of the equipment, such as whether it went from room to room – which is a breach – or whether it went to the cleaning area,” Wallace said. “We have found that 10 percent of the time it goes in the wrong direction, so that process flow is really critical. Same thing with instrumentation pans – by tagging the pan, staff can make sure that it goes through decontamination prior to going into autoclave.
Having practiced in that environment, I have seen those errors occur.”
Aiding the ED
A “seamless, longitudinal look at the path of care” is a valuable approach for measuring quality and securing patient safety, says Robert Hitchcock, MD, vice president and chief medical information officer at Dallas-based T-System.
As an emergency physician at Manatee Memorial in Bradenton, Fla., Hitchcock believed in the system so much that he joined the T-System staff to offer his clinical insights on making the product better.
“When I have a conversation about quality and safety with anyone, there are a few major issues with EMRs, specifically the quality of the medical record and what it does to medicine in the ED,” he said. “In this environment, the decisions the provider makes tend to be what the inpatient providers will go with during the continued course of treatment. That is good in the first 48 hours, but you need a readable, accurate up-to-date record and it needs to provide enough information so that the downstream provider understands your thought process.”
Storing clinical data for immediate use is a critical safety function, and Salt Lake City-based Healthcare Quality Catalyst employs an electronic enterprise data warehousing system to help physicians with decision support.
“Our data warehouse extracts information from source systems and from those copies we develop subject area data marts that deal with specific medical conditions, such as heart failure, diabetes and hypertension,” said CEO David Burton, MD.
Having instant access to information greatly assists in patient safety protocols, such as risk assessment for decubitus ulcers in ICU, Burton said.
“The first step in prevention is assessment using the Braden Scale and if the score is less than 14, the patient is at an increased risk for an ulcer,” he said. “The next step is to implement a prevention protocol, such as special mattress, turning the patient frequently and avoiding caustic substances.”
When it comes to patient safety, the patients themselves must also take responsibility in their own care plan, says Gary Kolbeck, president of Sioux Falls, S.D.-based Lodgenet Healthcare. Through a multimedia presentation, educational videos are designed to “motivate and activate” patient participation levels, he said.
“Our videos tell patients they have a role and that our information gives them better control of their care,” he said. “We help them understand things like their disease state, care team, treatment schedule and wellness elements that help prevent hospital readmissions.”