Cracking The Code: The Differences Between Good & Bad Health IT

CRACKING THE CODE The Differences Between Good and Bad Health IT From a Programmer's Perspective Over half of all physicians and 80% of hospitals have started keeping electronic medical records. 80% Unfortunately, these systems aren't foolproof, and a poorly designed program can result in dangerous medical errors and a poor patient experience. Health IT programmers need to anticipate the potential pitfalls for these types of programs to help streamline their systems in a safe and efficient manner. Hospitals FINDING PATIENTS Searching "Ann Smith" . e Searching "Ann Smith" . . A No "Ann Smith" found!! No "Ann Smith" found!! Try Anne Smith Patient Name: Anne Smith, Disease: Heart Surgery.more. Try Anny Smith Search again Patient Name: Anny Smith, Disease: Kidney Trans.more. See More Suggestions Search results do not Search clearly shows all possible results. prominently display all patients with the same or similar names. In a single facility, a survey done over a 3-month period showed that multiple patients had the same last name 28% of the time. 28% 3 Months EVALUATING TEST RESULTS Long pages of information make it difficult to catch small abnormalities Bolded, underlined, and highlighted features on concise reports make it easier to digest data. in test results. Poorly designed reference ranges require both vertical and horizontal scrolling, confusing viewers. Built-in redundancies, such asa verbal confirmation between departments, help prevent errors. REPORTED PROBLEMS DUE TO TECHNOLOGICAL FAILURES 2% - 1% Network Down or Slow 2% 10% 4% System Interface Issues Computer System Down or Too Slow 5% Software Issue Output / Display Error Output Device Down or Unavailable 9% Data Capture Down or Unavailable 7% - Data Loss Software Not Available 9% ENTERING CASE INFORMATION Disease Symptoms Previous Time Record Name Father's Name Contact Address Terms and Condtons Insurance Informaton Hospital Terms Stationary Forms Accident Laws Police Lans Disease Disease. Symptoms Previous Time Record Insurance Information Hospital Terms Terms and Con Symptoms Time Record Features the patient's name and ID information prominently on all screens, including a patient photograph. Patient name and ID information are not constantly visible. Font is small and difficult to read. Links are small, making it easy Requires physicians to re-enter the patient's information before completing an order. to mis-click. Uses easily readable fonts and does not cluster links together. The simple inclusion of a re-entry screen where physicians had to Errors reduced manually enter patient information before completing orders by 41% reduced wrong patient errors by 41%. ORDERING PRESCRIPTIONS Preseription Only permethrin, crotamitor, and suljur ointment are considered safe for treating children yourger than age 2.Crusted (Norwegian) seabies (rare) often reguires multiple treatments, Some times with more than one Prescription Pill Dosage Time 10mg Aitriptyline 20mg Alprazolam 5mg Nortriptyline 10mg 5mg 25mg 10mg 5mg Xanax 0700 1000 1000 1300 Ritalin Doxepin Pamelor 1300 1700 2100 Nardil 2100 medicine, Adheres to a too-rigid structure, making it difficult to accurately prescribe combinations of prescriptions or partial tablets. Uses sophisticated rounding strategies and weight measurements to facilitate complex prescriptions including alternative formats and combinations. Poorly orders data entry, such as asking for the total number of pills before asking for the size of the dose, number of daily doses, and duration of the treatment. Xxxx xxxxx Of 324 error reports evaluated in one study, 95% were related to medication error. DEALING WITH DOSING Medicine Dosage Medcine Dosage Carboprost Dinoprostone Miepri Carbeprost System populates a default dosage field for prescriptions. System requires manual entry of doses. System alerts to prescriptions submitted with incomplete information. System overrides physician's orders, replacing them with a default value. System provides a default value for incomplete fields. TYPES OF MEDICATION ERRORS 62 60 LJ 51 52 40 39 34 30 20 18 10 10 2 2 2 Wrong: Dose Omission Dose/Overdosage Extra Dose Dose/Underdosage Prescription/Refill Delayed Drug Medication List Incorrect Dosage Form Monitoring Error Unauthorized Drug Duration Rate (intravenous) Other Route Strength/Concentration Technique Time **Total number of reports - 307 Patient DISCHARGE This one field requirement probably resulted in hundreds of extra hours of physician time per day throughout the hospital system, without any enhancement in patient care or safety. -Val Jones, founder and CEO of Better Health Forsanal intormation Father's Nam ood Group Name Father's Name, Nominae Contact Addross Emergency Address sease mptoms vious rance Information ospital Terms Terms and Conditions toms Terms and Condti Insurane intuma Hopital Torms rd Time Record Hospital conditio on all and plicable Complex requirements slow down the discharge process by forcing the doctor to enter more information Makes the necessary information readily available for physicians following up with a patient after discharge. than necessary. Generates personalized discharge Generates a copious amount of mostly generalized discharge instructions. instructions with relevant details and excellent readability. ADELPHI UNIVERSITY http://onlinemshidegree.adelphi.edu/ Sources: http://www.annemergmed.com/article/S0196-0644(13)00506-4/fulltext#sec3 http://www.patientsafetysolutions.com/docs/July_17_2012_More_on_Wrong_Patient_CPOE.htm http://www.webmm.ahrq.gov/case.aspx?caselD=1&searchStr=shojania http://patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2013/Sep; 10(3)/Documents/sep; 10(3).pdf http://www.kevinmd.com/blog/2013/08/sad-state-emrs-harm-good.html http://money.cnn.com/2013/09/01/pf/electronic-health-records.moneymag/ http://www.patientsafetyauthority.org/ADVISORIES/AdvisoryLibrary/2012/Dec;9(4)/Publishinglmages/113_tab4.jpg NUMBER OF REPORTS 50