Health IT including EHRs and patient triage chatbots can help improve care, but can also contribute to potential patient harm without the proper safeguards in place.
Despite widespread adoption of EHRs, neither The Joint Commission standards nor CMS policies mandate adherence to health IT best practices; "Yet mounting evidence indicates a clear connection between the use of technology and safety—where EHRs can improve care and where they might contribute to patient harm," according to a July 21 Pew Research report.
The Pew Charitable Trusts and the MedStar Health National Center for Human Factors in Healthcare partnered identified a series of best practices hospitals should adopt to better monitor and address tech-related issues. The organizations reviewed The Joint Commission's requirements, completed 10 interviews with hospital administrators, informaticists and health IT usability and safety experts to identify 10 new potential accreditation requirements.
Here are three recommendations to improve clinical decision support tools in EHRs:
1. Roll out CDS for high-risk clinical scenarios, such as alerts for certain drug interactions or allergy issues, which include conditions associated with more frequent patient safety problems.
2. Implement a process for assessing CDS functionality and maintenance because CDS functions may change over time and changes to the health IT system features or hospital workflow could result in CDS tools not functioning the way clinicians intended.
3. Monitor if and how clinicians use CDS to help identify safety risks, such as the frequency with which alerts are overridden to help better design alerts so physicians don’t dismiss them.
Here are seven recommendations to improve health IT:
1. Establish a committee with clinical and health IT expertise that meets regularly to review content and structure of order sets to ensure patients receive the properly intended care consistent with clinical guidelines.
2. Put inplace processes and organizational structure to provide control and safeguards for implementing, configuring, customizing and updating the IT system.
3. Promote regular, in-person training courses, online training materials or other processes to ensure staff keep learning new skills and behaviors and can provide employees with support on how to use the health IT system safely and effectively, especially after upgrades that affect usability.
4. Implement a process to identify health IT hazards, such as frequent testing of EHRs to detect errors or conducting regular safety assessments using self-assessments.
5. Establish a health IT hazard reporting process for staff so they can report any actual or potential safety issues they may encounter.
6. Create a process for hazard analysis and resolution, which entails identifying contributing factors to the hazard and developing a plan to reduce the threat. Appointing a committee to regularly review and identify hazards can help improve issues by working with the internal IT staff and/or the EHR vendor.
7. Promote health IT awareness among staff through initiatives such as an intranet with a safety section to describe safety risk and hazards mitigation strategies as well as email communication with affected providers.
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