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HITs and Misses

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HITs and Misses

By Jock Hoffman, CRICO

Related to: Communication, Emergency Medicine, Primary Care, Nursing, Obstetrics, Other Specialties, Surgery

Background

Two key components of health care still in search of ideal HIT support systems—clinical decision making and the follow through related to those decisions—are ubiquitous in medical malpractice cases. Of the 1,211 cases filed against CRICO-insured clinicians and institutions since 2003, 485 cite decision-making errors and 497 cite failures related to follow-through. With an average incurred loss above $640,000 for decision making errors, and over $700,000 for breakdowns in follow-through, these cases represent a significant portion of CRICO’s overall exposure.

Our Recommendation

Those cases, and the near misses that are caught before any patient is harmed, also represent a plethora of opportunities for HIT solutions to reduce that exposure and aid safer patient care. Organizations in which IT and MDs (and RNs) fully collaborate on technology solutions enable successful implementation and ongoing improvement. Settings in which the designers and the users do not fully collaborate risk inappropriate design and incomplete adoption of their HIT systems. That, in turn, opens the door to ill-advised workarounds and undetected patient safety risks. One way to assess how confident or “exposed” you feel, is to review the following concerns related to the HIT systems you use, and ask yourself: Do I (or should I) worry about this?

Copying/Pasting/Prepopulating: Input or roll over of incorrect patient information due to the practice of pre-populating, copying/pasting, or automatically rolling over information (to avoid re-entering data).

Hybrid Records: Misinterpretation of the status of a patient who has unique clinical data stored in both an electronic record and a paper system.

Incompatible Systems: Inability to construct a complete and up-to-date profile of a patient whose clinical data resides on multiple systems not designed to interface with each other.

Unclosed Loops: Failure to receive or recognize critical patient information when a system is unable to close the loop on tests, referrals, and transitions in care.

Workarounds: Failure to recognize crucial patient information because an overly sensitive or complex decision support tool/system was overridden or worked around.

more...

If you find your blood pressure going up as you read through the list, this might be a good time to revisit and reprioritize your systems improvements wish list, and advocate to allocate resources accordingly.

Additional Materials


June 1, 2008
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