Optimizing EMR Workflow to Reduce Medical Errors and Provider Frustration

Dan Sullivan, MD, JD, FACEP

Copyright © 1998 - 2016, The Sullivan Group, All Rights Reserved. These materials comprise the proprietaryinformation of The Sullivan Group. Unauthorized use, copying or dissemination of these materials is strictly prohibited.

2RSQ® Solutions

2RSQ® Solutions

PresenterDan Sullivan, MD, JD, FACEP

Dr. Sullivan is the President and CEO of The Sullivan Group, a leader in risk management, patient safety and quality improvement solutions for healthcare providers.

Dr. Sullivan is a board certified Emergency Medicine physician and a Fellow in the American College of Emergency Physicians (ACEP).

3RSQ® Solutions

3RSQ® Solutions

PresenterDan Sullivan, MD, JD, FACEP

Dr. Sullivan is an expert in building risk management, patient safety, and evidence-based medicine seamlessly inside of electronic medical records. The Sullivan Group’s EMR Risk Management Module is currently in place in over 500 U.S. hospitals.

4RSQ® Solutions

4RSQ® Solutions

Learning Objectives

Create an awareness of the current “State of the Union” as it applies to patient safety and practitioner frustration when using EHR/EMRs

Understand the impact of EHR technology on patient care.

Share ideas on optimizing EMR/EHR workflow to improve safety and reduce practitioner frustration.

5RSQ® Solutions

5RSQ® Solutions

6RSQ® Solutions

6RSQ® Solutions

7RSQ® Solutions

7RSQ® Solutions

8RSQ® Solutions

8RSQ® Solutions

9RSQ® Solutions

9RSQ® Solutions

10RSQ® Solutions

10RSQ® Solutions

Allocation of Physician Time in Ambulatory Practice:

A Time and Motion Study in 4 Specialties Allocation of Physician Time in Ambulatory Practice

Ann Intern Med. Published online 6 September 2016 doi:10.7326/M16-0961 © 2016 American College of Physicians

11RSQ® Solutions

11RSQ® Solutions

Participants: 57 U.S. physicians in family medicine, internal

medicine, cardiology, and orthopedics who were observed for 430 hours; 21 of them also completed after-hours diaries.

Measurements: Proportions of time spent on 4 activities (direct

clinical face time, electronic health record [EHR] and desk work, administrative tasks, and other tasks) and self-reported after-hours work.

12RSQ® Solutions

12RSQ® Solutions

Results: During the office day, physicians spent 27.0%

of their total time on direct clinical face-time with patients and 49.2% of their time on EHR and desk work.

The 21 physicians who completed after-hours diaries reported 1 to 2 hours of after-hours work each night, devoted mostly to EHR tasks.

13RSQ® Solutions

13RSQ® Solutions

American Health Information Management Association (AHIMA)

according to a September AHIMA report. http://www.healthcareitnews.com/news/ehr-copy-paste-better-think-twice

14RSQ® Solutions

14RSQ® Solutions

It has become such a compliance and payment problem that the U.S. Department of Health and Human Services Secretary Kathleen Sebelius together with Attorney General Eric Holder wrote a letter last year to industry medical groups underscoring the seriousness of doctors "gaming the system, possibly to obtain payments to which they are not entitled."

15RSQ® Solutions

15RSQ® Solutions

Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy (2013)

16RSQ® Solutions

16RSQ® Solutions

17RSQ® Solutions

17RSQ® Solutions

Why was the HITECH Act Created?

The Health Information Technology for Economic and Clinical Health Act (HITECH) legislation was created in 2009 to stimulate the adoption of electronic health records (EHR) and supporting technology in the United States.

18RSQ® Solutions

18RSQ® Solutions

19RSQ® Solutions

19RSQ® Solutions

Meaningful Use Definition & ObjectivesMeaningful Use DefinedMeaningful use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce

health disparities Engage patients and family Improve care coordination, and population

and public health Maintain privacy and security of patient health

information

20RSQ® Solutions

20RSQ® Solutions

21RSQ® Solutions

21RSQ® Solutions

Leading Causes of Death in U.S.

22RSQ® Solutions

22RSQ® Solutions

Used with permission from and art by Caroline Laplante http://claplante.blogspot.ca/

23RSQ® Solutions

23RSQ® Solutions

A PromiseUnfulfilled

24RSQ® Solutions

24RSQ® Solutions

Time For AChange!!

A PromiseUnfulfilled

25RSQ® Solutions

25RSQ® Solutions

Human Factors Engineering

26RSQ® Solutions

26RSQ® Solutions

27RSQ® Solutions

27RSQ® Solutions

28RSQ® Solutions

28RSQ® Solutions

29RSQ® Solutions

29RSQ® Solutions

Vital Signs Re-EvaluationNational Profile We looked at vital signs in 90,000 patients.

9,000 were very abnormal. 16% of patients with very abnormal vital signs

are discharged without a single repeat. This is a common finding in

failure to diagnose cases.

30RSQ® Solutions

30RSQ® Solutions

Vital Signs Re-EvaluationNational Profile We looked at vital signs in 90,000 patients.

9,000 were very abnormal. 16% of patients with very abnormal vital signs

are discharged without a single repeat. This is a common finding in

failure to diagnose cases.

31RSQ® Solutions

31RSQ® Solutions

Vital Signs Re-EvaluationNational Profile We looked at vital signs in 90,000 patients.

9,000 were very abnormal. 16% of patients with very abnormal vital signs

are discharged without a single repeat. This is a common finding in

failure to diagnose cases. cases.

32RSQ® Solutions

32RSQ® Solutions

Vital Signs Re-EvaluationNational Profile We looked at vital signs in 90,000 patients.

9,000 were very abnormal. 16% of patients with very abnormal vital signs

are discharged without a single repeat. This is a common finding in

failure to diagnose cases.

33RSQ® Solutions

33RSQ® Solutions

34RSQ® Solutions

34RSQ® Solutions

Data from CRICO-2011 EM Analysis

35RSQ® Solutions

35RSQ® Solutions

Data from CRICO-2011 EM Analysis

36RSQ® Solutions

36RSQ® Solutions

Data from CRICO-2011 EM Analysis

37RSQ® Solutions

37RSQ® Solutions

Data from CRICO-2011 EM Analysis

38RSQ® Solutions

38RSQ® Solutions

39RSQ® Solutions

39RSQ® Solutions

Vital Sign Solution

40RSQ® Solutions

40RSQ® Solutions

Vital Sign Solution

41RSQ® Solutions

41RSQ® Solutions

Vital Sign Solution

42RSQ® Solutions

42RSQ® Solutions

Extremity Lacerations

What do we miss? Vascular injury Neurologic injury Tendon injury

Why? Because we are human!

The solution?

43RSQ® Solutions

43RSQ® Solutions

44RSQ® Solutions

44RSQ® Solutions

45RSQ® Solutions

45RSQ® Solutions

46RSQ® Solutions

46RSQ® Solutions

47RSQ® Solutions

47RSQ® Solutions

48RSQ® Solutions

48RSQ® Solutions

49RSQ® Solutions

49RSQ® Solutions

The HPI Must Talk to the Review of Systems

50RSQ® Solutions

50RSQ® Solutions

51RSQ® Solutions

51RSQ® Solutions

The Entire Medical Record Should Talk to Medical Decision Making

52RSQ® Solutions

52RSQ® Solutions

The HPI and PE Should Talk to Medical Decision Making

53RSQ® Solutions

53RSQ® Solutions

54RSQ® Solutions

54RSQ® Solutions

55RSQ® Solutions

55RSQ® Solutions

56RSQ® Solutions

56RSQ® Solutions

57RSQ® Solutions

57RSQ® Solutions

58RSQ® Solutions

58RSQ® Solutions

59RSQ® Solutions

59RSQ® Solutions

60RSQ® Solutions

60RSQ® Solutions

61RSQ® Solutions

61RSQ® Solutions

HR = 120

POx = 92%

62RSQ® Solutions

62RSQ® Solutions

63RSQ® Solutions

63RSQ® Solutions

64RSQ® Solutions

64RSQ® Solutions

Nurse Enters Birth Weight on an Infant

65RSQ® Solutions

65RSQ® Solutions

If the child is less than 60 days of age, the program asks for a current weight

66RSQ® Solutions

66RSQ® Solutions

Neonatal Auto Weight Calculator with Alerts

67RSQ® Solutions

67RSQ® Solutions

Neonatal Auto Weight Calculator with Alerts

68RSQ® Solutions

68RSQ® Solutions

Neonatal Auto Weight Calculator Alert

69RSQ® Solutions

69RSQ® Solutions

70RSQ® Solutions

70RSQ® Solutions

Syndrome Surveillance

71RSQ® Solutions

71RSQ® Solutions

Kawasaki’s Syndrome

History of fever from caregiver (HPI) Cervical adenopathy (PE neck) Mucous membrane changes:

lips, tongue (PE HEENT) Changes in the peripheral

extremities: swelling, desquamation (PE extremities)

Rash on the trunk (PE skin)

72RSQ® Solutions

72RSQ® Solutions

73RSQ® Solutions

73RSQ® Solutions

74RSQ® Solutions

74RSQ® Solutions

75RSQ® Solutions

75RSQ® Solutions

Summary

Human factors engineering is one of many opportunities to impact the practitioner/ patient experience.

Correctly applied, it can improve quality and safety and reduce medical errors.

Correctly applied, it can improve practitioner satisfaction and reduce frustration.

It’s the future; let’s get there ASAP. It’s an exciting ride and the sky is the limit!

76RSQ® Solutions

76RSQ® Solutions

Questions?

Please contact Brant Roth at broth@thesullivangroup.com for information about TSG’s RSQ® Solutions.

Please contact your Bermuda brokers for more information about the XL Catlin-TSG partnership.

Thank You