Follow-up on Abnormal Cancer Screenings: Creating a system-wide, EMR-based solution to improve patient safety and reduce medical errors Cambridge Health Alliance David Osler, MD MPH Louise Weed, MS

The Problem “Achieving a model patient safety profile: An Ambulatory RAP (Risk Appraisal Plan) for Cambridge Health Alliance.” Presented by CRICO to CHA in 2011 CHA’s average test results management score from CRICO’s Office Practice Evaluations: 72% Of all malpractice claims , contributing factors included: –Communication in 42% of cases –Clinical systems in 37% of cases Staff overworking with ineffective systems

The Goal Ensure that 100% of our patients with abnormal results are aware, have appropriate documentation, and a follow-up plan

The Method Create an automated, system-wide safety net for all patients with abnormal cancer screenings –Automated patient lists embedded in our EMR (Epic) –Audit checklists built into EMR –Automated removal of patients based on checklist Find/ create the data: –Pap, PSA, Mammogram –Partnership with appropriate departments Build patient lists and audit tools –Consensus on “follow-up”, integration with other safety tools

Outcomes Pilot in three Primary Care health centers Percentage with all steps completed –Patients whose records needed updating –Near-misses Assessment reports Nursing and Provider satisfaction Change in start date

Challenges, Lessons Learned It takes a village (and then some)! –Perseverance and partnership Workflow expectations and reality –Ongoing trust issues with automation –Expectations between Nurses and Providers –Changes in screening and f/u guidelines –Who “owns” the patient – PCP vs. Specialist –Definition of abnormal Accountability & Communication Pros and Cons of IT based systems No system is perfect