On October 6th, 2013, Teri Dreher posted an article on ‘Hospital Safety Statistics: Worse than we throught’ on the North Shore Patient Advocates site. Teri is well acquainted with the complexities of the modern healthcare care system and has 36 years of clinical experience in Critical Care nursing.
The grim report of patient deaths (200-400K annually) due to preventable medical errors is a pre-EHR number or prior to the paperless transition initiated by Obamacare. There are significant studies / reports on the impact of paperless transition on care providers’ productivity, ranging from the number of clicks per emergency doctor on swimsuits online EMR, percentage of time spent on EMR (44%) versus time spent with patient (12%), time spent on medical diagnosis (13%) or the percentage of mis-diagnosis due to lack of usability from existing EMR solutions. Such indications would suggest same level of medical errors as a ‘best case’ or more likely a worsening situation.
Let’s look at the issues on different levels, starting with today’s situation on preventable medical errors. 40% of preventable medical errors are due to miscommunication, omissions of medical activities, bad hand-off processes, etc. Solutions today are all based on manual processes, putting the burden on care providers who are already stretched too thin. To Err is Human is a perfect title to depict the source of the problems. We are expecting care providers to perform all activities tracking, monitoring, follow-up – manually, based on their memory within a hectic, critical care environment. Those tasks divert care providers from their principal task – patient care. A Healthcare environment designed to support care providers, must be based on Proactive, Automated Information. Proactive is about reaching out to the right care provider for the right treatment, at the right time. Proactive is about removing the requirements for care providers to pull, monitor, track, search for medical information instead of focusing on patient care. Automated is to rely on a workflow in support of care coordination instead of manual process to ensure different care providers carry out the medical activities.
Post-EHR has created additional issues impacting patient care quality. As patient medical data is now being put under electronic form, EMR solutions do not fill the medical tools gap between paper and paperless. Nurse flow sheets in critical care environment is one of many examples. Once the paperless transition is completed, without filling the void of medical tools from paper environment, care providers are forced to spend more time looking for data from EMR than focusing on patient care. Less time on patient care would lead to more medical errors. How many of such medical errors would turn deadly? Oregon Health and Science University has conducted a study on EMR usability and reported that 60-70% of simulated patient conditions have been misdiagnosed by care providers, where additional EMR trainings or level of medical expertise do not have a major positive impact on outcome. EMR transition is a good thing in order to open up for more automation, efficiency for cares providers. The key part is opening up – but EMR vendors fail to close the gaps on care environments and medical tools used by care providers previously. The solution must be brought in with the focus on emphasizing Patient Medical Information, giving care providers the control, navigation in parity with existing paper care environments.
The following YouTube video depicts what a Proactive Automated Environment can address (http://www.youtube.com/watch?v=5dv-50dXuf0). The second video focuses on how Patient Medical Information can be delivered in order to close the tool gaps from paper to paperless (http://www.youtube.com/watch?v=tLGsaKvrtOA).
Hospital administrators, MBA would soon face this huge issue since it would impact the bottom line of their business. Due to the simple fact – it is about productivity of care providers, hospital staff included. Nurses would be impacted the most and would see the most adverse situation on productivity. This is accelerated since by the end of 2014, the paperless transition is supposed to be complete; therefore, the productivity issue would raise to the top of the hospital agenda – simply because it would need more staff to support the same outcomes.