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ECRI Institute Releases Annual List of Top 10 Patient Safety Concerns

March 13, 2017
by Heather Landi
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Healthcare providers have troves of information to manage, and the advent of electronic health records (EHRs) has brought this challenge to the forefront, which is why the ECRI Institute cited information management in EHRs as its top patient safety concern in its annual executive brief.

The ECRI Institute, a non-profit organization focused on improving the safety, quality and cost-effectiveness of patient care, on Monday released its fourth annual Top 10 Patient Safety Concerns for Healthcare Organizations executive brief. According to the ECRI Institute, the annual list is meant to guide healthcare organizations on where to direct their patient safety initiatives.

In selecting this year’s list, the ECRI Institute relied on its Patient Safety Organization (PSO) event data, concerns raised by healthcare provider organizations, and on expert judgment to select the topics for the 2017 list. Since 2009, when ECRI Institute PSO began collecting patient safety events, the PSO and partner PSOs have received more than 1.5 million event reports and reviewed hundreds of root cause analyses.

“The 10 patient safety concerns listed in our report are very real,” Catherine Pusey, R.N., associate director, ECRI Institute PSO, said in a statement. “They are causing harm—often serious harm—to real people.”

 “The list does not necessarily represent the issues that occur most frequently or are most severe. Most organizations already know what their high-frequency, high-severity challenges are. Rather, this list identifies concerns that might be high priorities for other reasons, such as new risks, existing concerns that are changing because of new technology or care delivery models, and persistent issues that need focused attention or pose new opportunities for intervention,” the report authors wrote.

Topping the list this year is information management in EHRs. But the object is still for people to have the information that they need to make the best clinical decision," says Lorraine B. Possanza, program director, Partnership for Health IT Patient Safety, ECRI Institute. "Health information needs to be clear, accurate, up-to-date, readily available, and easily accessible.”

To this end, healthcare organizations must approach health IT safety holistically. According to the ECRI Institute, one key step is integrating health information management professionals, IT professionals and clinical engineers into patient safety, quality and risk management programs. “Other strategies include ensuring that users understand the system’s capabilities and potential problems, encouraging users to report concerns and investigating those concerns, engaging patients in information management and harnessing the power of EHRs to enhance patient safety,” the report authors wrote.

This is the second year in a row that health IT has topped the list of patient safety concerns. Last year, ECRI Institute identified health IT configurations and organization workflow that do not support each other as the No. 1 patient safety concern.

Second on this year’s list is patient deterioration, which can have catastrophic consequences if undetected. Over the past few decades, improved clinical protocols, training and education for providers, and public awareness campaigns have enabled speedier recognition of, and response to, stroke and ST-elevation myocardial infarction (STEMI).

Certain other conditions—including sepsis, some maternal conditions, and serious postsurgical complications—“need the same type of prompt recognition and attention in order for the patient to have a good outcome,” Patricia N. Neumann, R.N., senior patient safety analyst and consultant, ECRI Institute, said in a statement.

"People have seen how well the campaigns have worked for stroke and STEMI and how much they've improved outcomes," Neumann said. "What if those same principles could be applied to other conditions that require fast recognition and management? We could have a big impact on improving outcomes.”

Implementation and use of clinical decision support (CDS) ranked third on this year's list. CDS encompasses "tools that we use to ensure that the right information is presented at the right time within the workflow," Robert C. Giannini, patient safety analyst and consultant, ECRI Institute said. But if implementation or use is suboptimal, opportunities for CDS to aid decision making may be missed. Care could suffer, and patient harm could result, according to the ECRI Institute.

Healthcare organizations must design CDS systems judiciously; resources are available from HealthIT.gov, ECRI Institute, and others. A multidisciplinary team should have oversight. End users must be trained in the proper use of CDS, as well as their roles and responsibilities, and have access to support structures.

The reminder of the list was as follows:

Test result reporting and follow-up

Antimicrobial stewardship

Patient identification

Opioid administration and monitoring in acute care

Behavioral health issues in non-behavioral-health settings

Management of new oral anticoagulants

Inadequate organization systems or processes to improve safety and quality

As noted above, patient identification once again made the list of top patient safety concerns. According to the ECRI Institute, although the majority of the 7,613 events analyzed for ECRI Institute PSO’s Deep Dive: Patient Identification were caught before they caused patient harm, about 9 percent resulted in patient injury, including two deaths.

“The report brought national attention to an issue that most healthcare providers recognize as a significant problem,” William M. Marella, executive director, PSO operations and analytics, ECRI Institute, said.

Healthcare organization leaders can start to address this problem by fully supporting patient identification initiatives—by prioritizing the issue, engaging clinical and nonclinical staff, and asking staff to identify barriers to safe identification practices, for example.

In addition, the report authors noted that redundant processes for patient identification can increase the likelihood of preventing patient mix-ups. “Elements such as electronic displays and patient identification bands may be standardized. When used as intended, bar-code systems and other technologies can also support safe patient identification,” the report authors wrote.

The list and associated guidance is intended to help healthcare organizations identify priorities and aid them in creating corrective action plans. The ECRI Institute, in the report, also outlined how healthcare organizations can use the list:

Use this list as a starting point for conducting patient safety discussions and setting priorities. The list is not meant to dictate which issues an organization should address. Rather, it’s intended to serve as a catalyst for discussion about the top patient safety issues faced by the organization.

Determine whether your organization faces similar issues that should be targeted for improvement. Organizations can investigate whether they are experiencing problems with these or related concerns—and whether they have processes and systems in place to address them.

Develop strategies to address concerns. The full report on the top 10 patient safety concerns discusses key strategies for each issue, and other ECRI Institute resources provide more in-depth guidance on individual topics.

Consider applications across care settings. Although not all patient safety concerns on this list apply to all healthcare organizations, many are relevant to a range of settings across the continuum of care.

 

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Allscripts Sells its Netsmart Stake to GI Partners, TA Associates

December 10, 2018
by Rajiv Leventhal, Managing Editor
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Just a few months after Allscripts said it would be selling its majority stake in Netsmart, the health IT company announced today that private equity firm GI Partners, along with TA Associates, will be acquiring the stake held in Netsmart.

In 2016 Allscripts acquired Kansas City-based Netsmart for $950 million in a joint venture with middle-market private equity firm GI Partners, with Allscripts controlling 51 percent of the company. With that deal, Allscripts contributed its homecare business to Netsmart, in exchange for the largest ownership stake in the company which has now become the largest technology company exclusively dedicated to behavioral health, human services and post-acute care, officials have noted.

Now, this transaction represents an additional investment for GI Partners over its initial stake acquired in April 2016, and results in majority ownership of Netsmart by GI Partners.

According to reports, it is expected that this sale transaction will yield Allscripts net after-tax proceeds of approximately $525 million or approximately $3 per fully diluted share.

Founded 50 years ago, Netsmart is a provider of software and technology solutions designed especially for the health and human services and post-acute sectors, enabling mission-critical clinical and business processes including electronic health records (EHRs), population health, billing, analytics and health information exchange, its officials say.

According to the company’s executives, “Since GI Partners' investment in 2016, Netsmart has experienced considerable growth through product innovation and multiple strategic acquisitions. During this time, Netsmart launched myUnity, [a] multi-tenant SaaS platform serving the entire post-acute care continuum, and successfully completed strategic acquisitions in human services and post-acute care technology. Over the same period, Netsmart has added 150,000 users and over 5,000 organizations to its platform.”

On the 2018 Healthcare Informatics 100, a list of the top 100 health IT vendors in the U.S. by revenue, Allscripts ranked 10th with a self-reported health IT revenue of $1.8 billion. Netsmart, meanwhile, ranked 44th with a self-reported revenue of $319 million.

According to reports, Allscripts plans to use the net after-tax proceeds to repay long-term debt, invest in other growing areas of its business, and to opportunistically repurchase its outstanding common stock.

The transaction is expected to be completed this month.

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Study Links Stress from Using EHRs to Physician Burnout

December 7, 2018
by Heather Landi, Associate Editor
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More than a third of primary care physicians reported all three measures of EHR-related stress
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Physician burnout continues to be a significant issue in the healthcare and healthcare IT industries, and at the same time, electronic health records (EHRs) are consistently cited as a top burnout factor for physicians.

A commonly referenced study published in the Annals of Internal Medicine in 2016 found that for every hour physicians provide direct clinical face time to patients, nearly two additional hours are spent on EHR and desk work within the clinic day.

Findings from a new study published this week in the Journal of the American Medical Informatics Association indicates that stress from using EHRs is associated with burnout, particularly for primary care doctors, such as pediatricians, family medicine physicians and general internists.

Common causes of EHR-related stress include too little time for documentation, time spent at home managing records and EHR user interfaces that are not intuitive to the physicians who use them, according to the study, based on responses from 4,200 practicing physicians.

“You don't want your doctor to be burned out or frustrated by the technology that stands between you and them,” Rebekah Gardner, M.D., an associate professor of medicine at Brown University's Warren Alpert Medical School, and lead author of the study, said in a statement. “In this paper, we show that EHR stress is associated with burnout, even after controlling for a lot of different demographic and practice characteristics. Quantitatively, physicians who have identified these stressors are more likely to be burned out than physicians who haven't."

The Rhode Island Department of Health surveys practicing physicians in Rhode Island every two years about how they use health information technology, as part of a legislative mandate to publicly report health care quality data. In 2017, the research team included questions about health information technology-related stress and specifically EHR-related stress.

Of the almost 4,200 practicing physicians in the state, 43 percent responded, and the respondents were representative of the overall population. Almost all of the doctors used EHRs (91 percent) and of these, 70 percent reported at least one measure of EHR-related stress.

Measures included agreeing that EHRs add to the frustration of their day, spending moderate to excessive amounts of time on EHRs while they were at home and reporting insufficient time for documentation while at work.

Many prior studies have looked into the factors that contribute to burnout in health care, Gardner said. Besides health information technology, these factors include chaotic work environments, productivity pressures, lack of autonomy and a misalignment between the doctors' values and the values they perceive the leaders of their organizations hold.

Prior research has shown that patients of burned-out physicians experience more errors and unnecessary tests, said Gardner, who also is a senior medical scientist at Healthcentric Advisors.

In this latest study, researchers found that doctors with insufficient time for documentation while at work had 2.8 times the odds of burnout symptoms compared to doctors without that pressure. The other two measures had roughly twice the odds of burnout symptoms.

The researchers also found that EHR-related stress is dependent on the physician's specialty.

More than a third of primary care physicians reported all three measures of EHR-related stress -- including general internists (39.5 percent), family medicine physicians (37 percent) and pediatricians (33.6 percent). Many dermatologists (36.4 percent) also reported all three measures of EHR-related stress.

On the other hand, less than 10 percent of anesthesiologists, radiologists and hospital medicine specialists reported all three measures of EHR-related stress.

While family medicine physicians (35.7 percent) and dermatologists (34.6 percent) reported the highest levels of burnout, in keeping with their high levels of EHR-related stress, hospital medicine specialists came in third at 30.8 percent. Gardner suspects that other factors, such as a chaotic work environment, contribute to their rates of burnout.

"To me, it's a signal to health care organizations that if they're going to 'fix' burnout, one solution is not going to work for all physicians in their organization," Gardner said. "They need to look at the physicians by specialty and make sure that if they are looking for a technology-related solution, then that's really the problem in their group."

However, for those doctors who do have a lot of EHR-related stress, health care administrators could work to streamline the documentation expectations or adopt policies where work-related email and EHR access is discouraged during vacation, Gardner said.

Making the user interface for EHRs more intuitive could address some stress, Gardner noted; however, when the research team analyzed the results by the three most common EHR systems in the state, none of them were associated with increased burnout.

Earlier research found that using medical scribes was associated with lower rates of burnout, but this study did not confirm that association. In the paper, the study authors suggest that perhaps medical scribes address the burden of documentation, but not other time-consuming EHR tasks such as inbox management.

 

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HHS Studying Modernization of Indian Health Services’ IT Platform

November 29, 2018
by David Raths, Contributing Editor
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Options include updating the Resource and Patient Management System technology stack or acquiring commercial solutions

With so much focus on the modernization of health IT systems at the Veteran’s Administration and Department of Defense, there has been less attention paid to decisions that have to be made about IT systems in the Indian Health Service. But now the HHS Office of the Chief Technology Officer has funded a one-year project to study IHS’ options.

The study will explore options for modernizing IHS’ solutions, either by updating the Resource and Patient Management System (RPMS) technology stack, acquiring commercial off-the-shelf (COTS) solutions, or a combination of the two. One of the people involved in the analysis is Theresa Cullen, M.D., M.S., associate director of global health informatics at the Regenstrief Institute. Perhaps no one has more experience or a better perspective on RPMS than Dr. Cullen, who served as the CIO for Indian Health Service and as the Chief Medical Information Officer for the Veterans Health Administration

During a webinar put on by the Open Source Electronic Health Record Alliance (OSEHERA), Dr. Cullen described the scope of the project. “The goal is to look at the current state of RPMS EHR and other components with an eye to modernization. Can it be modernized to meet the near term and future needs of communities served by IHS? We are engaged with tribally operated and urban sites. Whatever decisions or recommendations are made will include their voice.”

The size and complexity of the IHS highlights the importance of the technology decision. It provides direct and purchased care to American Indian and Alaska Native people (2.2 million lives) from 573 federally recognized tribes in 37 states. Its budget was $5.5 billion for fiscal 2018 appropriations, plus third-party collections of $1.02 billion at IHS sites in fiscal 2017. The IHS also faces considerable cost constraints, Dr. Cullen noted, adding that by comparison that the VA’s population is four times greater but its budget is 15 times greater.

RPMS, created in 1984, is in use at all of IHS’ federally operated facilities, as well as most tribally operated and urban Indian health programs. It has more than 100 components, including clinical, practice management and administrative applications.

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About 20 to 30 percent of RPMS code originates in the VA’s VistA. Many VA applications (Laboratory, Pharmacy) have been extensively modified to meet IHS requirements. But Dr. Cullen mentioned that IHS has developed numerous applications independently of VA to address IHS-specific mission and business needs (child health, public/population health, revenue cycle).

Because the VA announced in 2017 it would sundown VistA and transition to Cerner, the assessment team is working under the assumption that the IHS has only about 10 years to figure out what it will do about the parts of RPMS that still derive from VistA. And RPMS, like VistA, resides in an architecture that is growing outdated.

The committee is setting up a community of practice to allow stakeholders to share technology needs, best practices and ways forward. One question is how to define modernization and how IHS can get there. The idea is to assess the potential for the existing capabilities developed for the needs of Indian country over the past few decades to be brought into a modern technology architecture. The technology assessment limited to RPMS, Dr. Cullen noted. “We are not looking at COTS [commercial off the shelf] products or open source. We are assessing the potential for existing capabilities to be brought into “a modern technology architecture.”

Part of the webinar involved asking attendees for their ideas for what a modernized technology stack for RPMS would look like, what development and transitional challenges could be expected, and any comparable efforts that could inform the work of the technical assessment team.

 

 

 


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