- Health IT has become an integral part of the care continuum, offering the promise of optimal, standardized care delivery. However, poor development and implementation of electronic health records (EHRs) can contribute to adverse patient safety events, including diagnostic and medication errors.
ECRI Institute has consistently cited poorly designed health IT systems as a major cause of medication management and diagnostic issues, which can lead to care gaps, unnecessary procedures, and patient harm.
The organization listed diagnostic errors as its number-one patient safety concern for 2018, and highlighted the role that flawed health IT systems can play in perpetuating these problems.
To ensure health IT tools are contributing to safe, effective patient care, ECRI created the Partnership for Health IT Patient Safety, a multi-stakeholder collaborative that aims to address issues relating to tracking diagnostic results and medication changes.
These issues are often referred to as “closing the loop”, and they are prevalent across all practice settings.
In a recently released report, the collaborative outlines the steps stakeholders should take to reduce diagnostic and medication errors with health IT.
“The goal of this Partnership workgroup was to look for technology solutions that all stakeholders could implement to close the loop—the tools provided here will help to do just that,” said ECRI Institute's Lorraine Possanza, DPM, JD, MBE, program director.
What are the top three steps stakeholders should take to optimize their health IT solutions, reduce diagnostic and medication errors, and improve patient safety?
Develop health IT solutions to communicate the right data
Efficient communication among providers, pharmacies, and patients is a critical part of safe, error-free care. Health IT solutions that can seamlessly transfer information across disparate systems are required to enable collaboration between members of the care team.
In order to achieve this goal, health IT developers, rule makers, and organizational leaders must develop standardized clinical definitions.
“One basic requirement for effective implementation is the use of standard clinical vocabulary and definitions for reporting of diagnostic results,” the ECRI team wrote.
“This recommendation requires rulemaking by government authorities, development of standards by provider and professional organizations, implementation of these standards into commercial solutions, and enforcing the use of these standards by organizational leadership and health IT developers.”
To further improve communication among stakeholders, the group advised health IT developers to modify existing electronic health record (EHR) functions to effectively deliver information to clinicians. These modifications could include automatic messages or emails to alert providers of critical results.
Developers can also make additional EHR adjustments to reduce alert fatigue, the team noted.
“Alerts must be differentiated by severity, including low, medium, and high severity,” the workgroup stated. “The criticality of an alert should be in direct correlation with how intrusive it may appear to users.”
Finally, the team recommended that providers use existing patient-facing technology to notify patients of diagnostic findings, including patient portals, mobile applications, and secure email and text messaging.
For patients without access to digital tools, the team states that alternative methods such as postal mail should be available.
Implement EHR solutions to track diagnostic results and medication changes
Although tracking medication changes and diagnostic results can be time-consuming, it is necessary for organizations to avoid error and enhance patient safety.
The team recommended that organizations review and revise their existing workflows and results management processes to determine where they can use health IT to improve tracking deficiencies.
“Organizations must use existing EHR functionality to initiate tracking of issues related to closing the loop, including review of incomplete orders, results not reviewed, results not transmitted to the provider or patient, and results not reviewed by the patient on the portal,” the workgroup wrote.
“Automatic tracking of these events and using a dashboard to show the prevalence of these events would be helpful.”
Additionally, the team advised organizations to conduct EHR audits and identify failures or gaps in care.
For example, organizations can flag when critical results are not followed by an appointment or medication change, or when actionable items remain incomplete.
To simplify the ordering and reporting of diagnostic results, the workgroup recommended that entities integrate their EHR interfaces with third-party systems, such as laboratory systems.
Leaders should ensure they have tools in place to check that these interfaces are performing optimally.
“Interfaces should be routinely and automatically monitored for failures and performance degradation using interface-specific tracking options,” the group stated.
“Prior to deployment, interface-monitoring tools should be tested, including usability testing, to ensure accuracy and correct interpretations by human observers.”
Adopt APIs and FHIR to store and share data
The team advised organizations to adopt technology that will allow them to seamlessly share data across the care continuum.
Application programming interfaces (APIs) and the Fast Healthcare Interoperability Resources (FHIR) play a critical part in facilitating communication between laboratories and hospitals, as well as in aggregating patient data from different sources, the group noted.
“When systems communicate, acknowledgment or documented actions can flow back, allowing automatic confirmation of loop closure,” the workgroup said.
The team also suggested that health IT developers create a feature within EHRs that documents providers’ response to a notification, such as ordering another test or modifying a patient’s medication.
Additionally, developers can optimize patient portals to allow patients to document their response to diagnostic results.
Patients should be able to report that they have seen their results. They should also have the option to document their requests to see their providers for follow-up appointments.
These modifications will further improve communication across the care continuum and help to ensure the accuracy of test results and medication changes.
EHRs, APIs, and patient-facing tools have the potential to streamline care delivery and enhance patient safety, but only when developed and implemented correctly.
With these guidelines, the Partnership for Health IT Patient Safety expects to optimize health IT use across the care continuum, which will allow providers to deliver improved patient care.
“These safe practice recommendations are a call to action,” the workgroup concluded.
“By executing these recommendations, people and organizations across healthcare (including patients) can help ensure that providers have the most accurate and up-to-date information, which is necessary to provide the most effective and efficient care to patients, leading to an improvement in outcomes.”