A Systematic Study of the Coordination, Communication, and Information Needs for Patient Care in an Academic Health Center James J. Cimino, M.D. Columbia University

Overall Objective To study information flow related to in- patient medication administration To identify areas in which information technology can be used to reduce errors: –responding to information needs –communication of information among team members to support collaboration

Staff James J. Cimino, M.D. (15%) Suzanne Bakken, D.N.Sc. (15%) Vimla L. Patel, Ph.D. (20%) Christine Curran, Ph.D. (15%) Tate Kubose, Ph.D. (70%) Lawrence McKnight, M.D. (50%) Peter Stetson, M.D. (50%) Research Assistant (TBN) (100%)

Budget Salaries (plus $42,111 cofunding)$166,006 Equipment (computer) $2,500 Supplies (software, food) $3,700 Publications $1,750 Survey subjects $5,625 Indirect costs $16,162 Total$195,743

Time Period D - Design C - Collection A - Analysis

Significance Medical errors abound Medication errors (adverse drug events) Our study will lead to an improved understanding of the problem Our study will provide a framework for developing information technology-based solutions

Background Studies of information needs –Inadequate information leads to adverse events –Underutilization of resources –Needs are often un-met Studies of communication and collaboration –Communication errors cause adverse events –Interrupt-driven –Reliance on face-to-face mode

Preliminary Studies Physician surveys (26) Nurse surveys (17) Physician focus groups (3 groups, 15 participants) Nurse focus groups (2 groups, 12 participants) Physician observations (2 rounds, 2 individuals)

Preliminary Results: Surveys and Focus Groups Physician: medication lists, links to pharmacy system, inefficiencies of paging system Nurses: drug information needed for patient education, drug administration policy and procedures, inefficiencies of paging system

Preliminary Results: Observations of Information Needs

Preliminary Results: Observations of Coordination Events

Objectives Expand on preliminary studies to categorize and enumerate proximal causes of medication errors –Un-met information needs –Ineffective communication Identify specific information technology- based solutions

Tasks Surveys Observational Studies Focus groups

Products: Proximal Causes of Errors Unmet information needs related to medications –Therapeutic decision making –Administration –Education of patients Ineffective communication –Order communication –Coordination of plan –Feedback on patient response

Products: Publications Informatics literature Medical literature

Products: Technologic Solutions Infobuttons Virtual whiteboard PalmCIS

AHRQ Proposal Three-year plan Year 1 Q1-Q4: design technologic solutions Year 2 Q1: Testing Year 2 Q2 to Year 3 Q1: controlled trial Year 3 Q2-4: Analysis

Contributions Specific characterizations of proximal causes of errors First step in a clinical trial for error reduction through information technology