Survey of Medical Informatics CS 493 – Fall 2004

Course Book – Primary focus PATIENT SAFETY ACHIEVING A NEW STANDARD FOR CARE Committee on Data Standards for Patient Safety Board on Health Care Services Philip Aspden, Janet M. Corrigan, Julie Wolcott, and Shari M. Erickson, Editors Institute Of Medicine To purchase this content as a printed book or as a PDF file go to

Summary Goal of the IOM report is help in identifying an information technology plan that will improve patient safety in this nation The health system needs to be able to prevent errors and when they do occur to be in a position to take corrective action The IT plan basically calls for the establishment of a National Health Information Infrastructure

NHII – why do you need it To provide access to all clinically pertinent information and to decision support tools for both clinicians and patients Automatically capture patient safety information during the process care is given

What is NHII ?

Dictionary Definition of Iatrogenic: induced by a physician's words or therapy (used especially for a complication resulting from treatment) Drumbeat of negative reports IOM Reports  “To Err is Human” – ,000 deaths attributed to medical errors  “Crossing the Quality Chasm”  “Patient Safety – Achieving a new standard of care” – 2004 JAMA Article – July 2000  Barbara Starfield – Is US Health Really the Best in the World 225,000 Deaths per year from Iatrogenic causes The number of deaths due to medical errors is equivalent to crashing a fully loaded jumbo jet every day of the year Airplane is the safest spot to be and a hospital bed is the most dangerous place to be

“To err is Human” Near Miss *: “An act of commission or omission that could have harmed the patient but did not do so as a result of chance, prevention or mitigation” Adverse Events: those care events that cause harm to patients (Iatrogenic) * IOM report on “Patient Safety – Achieving a new standard of Care”, pg 2

Common factors associated with errors Not following renal function decline and altering treatment appropriately Ignoring patient history of allergy to a certain class of medicines Wrong drug name, dosage or abbreviation Mistake in calculating drug dosage Mistakes in dosage frequency calculations

Crossing the Quality Chasm: A new health system for the 21 st Century IOM Report that identified six major quality goals:  Safety  Effectiveness  Patient Centeredness  Timeliness  Efficiency  Equitable

Safety Statistics McGlynn, E. A., S. M. Asch, J. Adams, J. Keesey, J. Hicks, A. DeCristofaro, and E. A. Kerr The quality of health care delivered to adults in the United States. New England Journal of Medicine 348 (26):2635–  Only 55% get appropriate care

Comparison to airline industry Pilots have access to all information needed to make decision Airplanes information systems are integrated with air traffic control systems Wrong decisions by pilots will lead to his/her death Black boxes record all decisions so errors can be analyzed. Every near miss and fatal errors are examined thoroughly by NTSB to ensure those can be avoided in future

Joint Commission on Accreditation of Healthcare Organization An organization whose mission is to promote safety and quality of care through the process of accreditation. Accredits more than 15,000 health care organizations in US Variety of programs supporting quality measurements including root-cause analysis of adverse events

Recommendation 1 Establishment of patient safety systems that rely on  Access to complete EHR and decision support tools at the point of care  Capture safety information – near misses and adverse events as a by-product of delivering care

Recommendation 2 Develop a National Health Information Infrastructure (NHII) that will serve as the foundation for all care Federal Government should provide incentives for the creation of NHII Healthcare providers should invest in EHR systems that support key capabilities facilitating safe delivery of care and implement a process of continuous improvement

EHR System Longitudinal collection of health information pertinent to care received by a person Access to any authorized person Knowledge and decision support tools Tools and infrastructure to provide efficient support for care delivery process

Recommendation 3 This recommendation focuses on roles and responsibilities of various government agencies  Department of Health and Human Services (DHHS) – to promote standards supporting patient safety  Consolidated Health Informatics (CHI) initiative with National Committee on Vital and Health Statistics (NCVHS) identify appropriate data standards and needs for standardizations  Agency for Healthcare Research and Quality (AHRQ) to oversee and support implementation efforts  The National Library of Medicine (NLM) to be the lead organization dealing with national clinical terminologies

Data Standards Data Interchange Formats  X12 – Administrative/Financial  HL7 – Clinical Data  DICOM – Medical Images  NCPDP – Prescription Data  MIB – Medical device data Coding/Terminologies  ICD, CPT, SNOMED, LOINC Knowledge Representations

Recommendation 4 Federal Government to encourage acceleration and adoption of standards in:  Clinical Data Interchange Eg. HL7 CDA  Clinical Terminologies Initially focusing on 20 priority areas  Knowledge Representation Develop standards for supporting evidence-based medicine practice and clinical guidelines

Recommendation 5 All healthcare systems should establish patient safety programs that:  Identify failures  Analyze failures  Redesign processes to prevent such failures from happening again

Recommendation 6 The federal government should pursue an applied research agenda that focuses on:  Knowledge Generation Identifying patients at high risk Analyze near-misses to improve overall safety Hazard analysis – retrospective and prospective techniques Identifying approaches that work the best Identifying the role of the patient  Develop tools To support early detection, prevention, data mining techniques  Dissemination Knowledge and tools

Recommendation 7 Entrust AHRQ with developing:  Adverse and near miss events taxonomy  Standardized format for reporting such event  Identifying data elements that needs to be used in such reporting and use of Eindhoven Classification Model – Medical Version  Clinical context documentation

Key Capabilities of an Electronic Health Record System Appendix E