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Workgroup Helps Healthcare Organization Replace or Eliminate Harmful Processes

Michelle Vincent MSN, RN, APRN- BC, Director of Quality, Twin Lakes Regional Medical Center located in Leitchfield, Kentucky, credits her team’s participation in an electronic medical record (EMR)-specific workgroup with helping their facility provide better care.

“At the end of the day, it really comes down to the impact of delivering safe patient care,” she said.

Because she routinely networks with atom Alliance, the Quality Innovation Network (QIN)-Quality Improvement Organization (QIO) and Kentucky Hospital Engagement Network (K-HEN) on quality issues, Vincent’s Quality Team naturally agreed to participate in a newly-formed EMR-specific workgroup.

Many of their facility tactics to increase the strength of Error–Reducing Strategies involve replacing or eliminating the processes that cause harm. According to Rank Order of Error–Reducing Strategies from John Hopkins University Health System (2011), weak strategies to prevent patient harm include:

  • Telling staff to be more careful,
  • Providing more education, rules and policies, checklists, and double check systems.

These are classified as methods to “facilitate,” which are weak on the rank order of error–reduction strategies.

As the Quality Director, Vincent teaches this concept daily and strives to challenge her team when reviewing near misses. She stretches their thinking beyond facilitative means and works toward replacing or eliminating harm. Some examples of “replace” strategies include “automation and computerization” and “standardization and protocols.” The strongest strategy to reduce error or harm is to eliminate it by means of “forcing functions and constraints” which are often driven electronically.

However, information technology (IT) teams do not always connect their efforts in building the EMR with this same mindset. IT teams are task-oriented and often considered a very high-demand resource. The teams are frequently charged with addressing the IT needs of multiple facilities.

Literature documents the benefit of designing EMR processes to help automate and computerize what might have previously been human processes of remembering the details of every patient’s need. Utilizing EMR forcing functions and constraints are well-known mechanisms to help reduce error and harm when designed appropriately.

Roughly eight years ago, much of their Meditech EMR was rolled out with measures in Congestive Heart Failure (CHF), Acute Myocardial Infarction (AMI), and Pneumonia. Over the years, a plethora of literature supports modifications made to help flag, alert, force hard stops, and trigger orders, etc.

Vincent admits she is not necessarily technologically savvy. She needed help from others to develop strong strategies to reduce error or harm in the IT EMR build. They needed assistance structuring IT requests so they could understand and prioritize them because the organization’s IT requests and resources were growing rapidly with competing demands.

Networking and sharing of hospital IT teams are not something that routinely occurs, but this workgroup has helped Vincent’s facility see how others have worked through obstacles to building up EMR practices and teams to deliver safer patient care. Vincent’s organization has already become comfortable with the process–sharing and relationships gained as a result of participating with some of their closest hospitals. They look forward to future connections with other workgroup participants.

She shared with Kristian Celesnik Hennette, Atom Alliance HIT Specialist, several examples of how participating in the workgroup has improved Twin Lakes’ processes to deliver safer care.

  • Twin Lakes recognized the need to move to the physician side of the EMR. EMR Assessment templates were only available on the nursing side and this was holding them back from consistent best practice in the timely care of patients at Moderate to High risk for Venous-Thromboembolism (VTE). Literature supports VTE risk assessments on the Physician EMR side, and their process slowly added physicians into the Progress Reporting (PDOC) side. Work to customize documentation and develop an electronic risk screen which would then trigger an order was being approached from the ground up and moving slowly. Vincent’s team made a request to explore how other facilities built EMR VTE processes with the workgroup. Her team quickly received very simple guidance for an existing feature they had been underutilizing for some time. As an Acute Care Hospital they were juggling many responsibilities, however, after discussion with a peer Critical Access Hospital, where Meaningful Use was the priority, they were given some clear end results, including screen shots of a successful processes already completed and in daily practice. Obtaining this shared information and delivering it back to Twin Lakes IT team on a silver platter was extremely helpful in the progress and speed of our movement in improving consistency in VTE prophylaxis with patients.
  • Instead of attempting to custom build from the ground up. They are now learning how to build all of Meditech’s best practices and have introduced this approach to the IT team, which has made it one of their priorities. They hope to proceed with the next steps in best practices for Sepsis, Immunizations, and Tobacco.
  • Vincent credits interdisciplinary team building (with both Quality and IT departments) for much of their success. This type of interdisciplinary team was encouraged by a work group call discussing challenges, networking, and sharing from others with similar EMR systems. When the Sepsis measure was implemented by CMS, the Twin Lake’s team was able to deliver information to their team to further their efforts in early risk identification and electronic sepsis alerts thanks to the advice shared on the call.

To learn if there is a workgroup for your facility’s EMR, please contact the HIT special for your state listed here
http://atomalliance.org/crosswalk-contact-page/.