Description
The SAFER guide is designed for self-assessment in nine areas to support organizations in the safer use of EHRs.
Review the SAFER guide on the HealthIT.gov website and use the resources and tools to do a self-assessment of your place of work and share your results by answering the following questions:
1- any surprises in the results,
2- what areas of opportunities or improvements did the self-assessment produce,
3- name three things you would include in an improvement plan.
(www.healthit.gov/buzz-blog/electronic-health-and-medical-records/safer-guides-optimize-safety)
SAFER Guides will help optimize safety
Jacob Reider | JANUARY 15, 2014
After a lot of hard work, we have combined evidence-based guidelines with practical advice to help you use your health information technology more safely. We’ve been working to post the Safety Assurance Factors for EHR Resilience (SAFER ) Guides since we highlighted them in our Health IT Patient Safety Action and Surveillance Plan last July.
There are nine SAFER Guides and each is designed to help care delivery organizations of all shapes and sizes conduct self-assessments of recommended practices in those areas we know are important to the safety and safe use of health information technology. The nine guides are:
High Priority Practices
Organizational Responsibilities
Patient Identification
CPOE with Decision Support
Test Results Review and Follow-up
Clinician Communication
Contingency Planning
System Interfaces
System Configuration
As a family physician who has worked for years on making sure that health information technology is leveraged to improve the safety and quality of health care, I’m thrilled to see the SAFER Guides fill a void: We’ve never before had a set of tools that care delivery organizations can use to perform self-assessments and developer customized improvement plans.
There is good evidence that health information technology improves the safety of care, especially when implemented using best practices. We’ve learned that there is a great deal of variability in how information technology is implemented and optimized in care delivery organizations, and this variability may account for some of the problems with the safety and reliability of health IT. These guides help enhance the likelihood that health information technology is implemented in a manner that aligns with best practices. For example, the SAFER Guide on Organization Responsibility should help the leadership of health IT-enabled organizations monitor critical components of the safety and safe use of health IT and make sure that a team of people – including clinicians and safety staff within the organization, as well as health information technology developers – is continuously engaged and focused on safety.The SAFER Guide on High Priority Practices is designed to help organizations explore where they can start to integrate health IT safety into their patient safety programs by identifying high-priority, high-risk practices associated with health IT use, and then suggesting which other SAFER Guides might help.
The SAFER Guides on Contingency Planning (which focuses on avoiding and recovering from downtimes), System Interfaces, and System Configuration should help organizations ensure that the health IT is safely designed, maintained, and configured, is reliably available and that the information therein is accurate and current within established expectations when each clinician uses it to care for patients.
The SAFER Guides on Patient Identification, CPOE with Decision Support, Test Results Review and Follow-up, and Clinician Communication will help practices establish systems that will allow them to be more confident that vital clinical information on the right patient will successfully reach clinicians who need it.
ONC and AHRQ, our partners in developing health IT safety tools, research, and education, will reach out to organizations and associations to encourage wider use of the SAFER Guides. We hope every sector of the healthcare industry will consider how they can make the SAFER Guides their own, including tailoring the content to their particular setting, specialty, and priorities. We look forward to feedback and hope everyone involved with health IT will consider how they can use the SAFER Guides to work on what must be a fundamental commitment and priority – using health IT to make patient care safer.
Please refer to the grading rubric. Submission must be at least 2 pages.
Unformatted Attachment Preview
CHAPTER 7
Electronic Health Records and Point-of-Care
Technology
INTRODUCTION
• Point-of-care (PoC) devices are health information technology (HIT) that includes devices and systems.
o These support clinicians in patient monitoring and electronic documentation.
• The Department of Defense implemented the Composite Healthcare System.
o To serve as the patient record for all military personnel worldwide.
• National Academy of Medicine (NAM) published the Computer-Based Patient Record in 1991.
o The first study that called for the widespread implementation of EHRs.
• Health Level Seven International (HL7) was formed.
o To develop standards for the electronic health records (EHRs).
• Fast Healthcare Interoperability Resource (FHIR) is a robust standard to interface multiple systems.
2
INTRODUCTION (Cont.)
• Office of the National Coordinator (ONC) is responsible for:
o overseeing the adoption of EHRs
o providing EHRs certifications
o developing a national infrastructure
▪ To support HIEs
• American Recovery and Reinvestment Act (ARRA) allocated US$29 billion for the adoption of EHRs.
• ONC and Centers for Medicare & Medicaid Services (CMS) manage the Health Information Technology
for Economic and Clinical Health (HITECH) Act.
o They administrate financial incentives.
▪ For organizations demonstrating “meaningful use” of EHRs.
3
EHR, PoC DEVICE INTEGRATION, AND INTEROPERABILITY
• Organizations today optimize the current systems.
o This helps meet the demands of the clinicians and patients.
• Interoperable systems must exchange data and present that data to a user.
• Certified EHRs must:
o comply with interoperability standards.
o provide various data standards to transfer data among systems.
• Older technologies are known as Legacy systems.
o They generate value for the organization.
• Interoperability and integrating disparate systems are crucial for a fully integrated EHR.
• PoC allows for on-the-spot testing with immediate results.
• FDA regulates all medical devices that interact with patients.
4
EHR, PoC DEVICE INTEGRATION, AND INTEROPERABILITY (Cont.)
• PoC devices are mobile and require Wi-fi access.
o In areas of low connectivity, accessing EHR becomes difficult.
• Maintaining data quality and integrity from the PoC system is challenging.
• Nursing informaticists are vital in defining the parameters for the clinical decision support (CDS) rules and
alerts.
• PoC are still tools to support care.
o It is necessary for the staff to remain vigilant in providing care.
• Associating and dissociating the medical equipment from the patient is important.
• This ensures data coming from the device into the record is from the right patient.
• Data coming from the PoC should be evaluated before acting.
• Change management processes accommodate:
o ongoing sustainability
o future development of the systems
5
EHR, PoC DEVICE INTEGRATION, AND INTEROPERABILITY (Cont.)
• Implementing the regulatory changes efficiently is challenging for the staff.
• Patient safety issues are managed by alerts or stops in the system.
• User requests should be managed to:
o ensure they meet the organization’s needs.
o enhance the workflows and functionality of the system.
• Nursing informaticists can manage the governance process to:
o define the prioritization of IT projects and the approval process for requests.
o manage changes.
• Health Insurance Portability and Accountability Act (HIPAA) security rule mandates a business continuity
plan (BCP) to be in place.
• Strategic development of EHR should impact HER and future development.
6
HEALTH IT SAFETY AND SAFER GUIDES
• SAFER guide is designed for self-assessment in nine areas.
o To support organizations in safer use of EHRs.
• SAFER guide assesses three phases:
o Phase 1—checking hardware, equipment, paper backup, data and software backups, policies, and procedures
o Phase 2—using HIT safely
o Phase 3—monitoring and testing approach for preventing and managing EHR downtime.
7
INSs, INFORMATICS NURSE (NI), AND SUPERUSER ROLES
• Nursing Informatics expert can assess the clinical aspects.
o How the EHR and PoC technologies affect the clinicians’ and the patients’ experience.
• INS support teams and the clinical setting.
o This improves the way technologies work for clinicians.
• Nursing Informaticists should:
o Work with the clinical staff
o Promote the use of EHR
• Superusers are the first-line resource to assist end users.
8
BENEFITS OF THE EHR FOR IMPROVING SAFETY AND QUALITY
• Benefits of EHRs are experienced by many such as providers and nurses.
• EHRs help providers identify and correct operational problems.
• Use of PoC devices has helped in providing critical information to clinicians.
• EHRs have:
• increased patient and family engagement in care.
• improved a provider’s ability to reduce medical errors.
• improved coordination of a single care event or the entire continuum of care.
• More advanced predictive and cognitive analytical tools are being used to improve EHR.
9
EHRs NEGATIVE IMPACT ON CLINICIANS AND A NATIONAL AGENDA TO
ADDRESS THE ISSUES
• With increased usage of EHRs, there are new emerging issues.
• Inadequate technology usability of EHRs have led to rise in clinician burnout.
o Rapid adoption of EHRs to meet the Triple Aim has increased documentation burden.
• Human factors science studies how humans interact with elements within a system.
• System usability involves design, interaction, and evaluation of clinicians’ use of HIT.
• This includes EHRs and PoC devices.
• Agile helps in rapid cycle improvements.
o Focused on the voice of the customer.
• National Library of Medicine aims to reduce documentation burden.
o Up to 75% by 2025
10
SUMMARY
• Primitive forms of EHRs have been in use for decades.
• EHR systems constantly evolve as per the needs of specific service lines.
• EHRs have led to improved patient safety and quality.
o Particularly related to certified technology under HITECH Act.
• Integration of PoC devices with the EHRs should always be considered.
• EHR implementation has improved care delivery significantly.
o It has also uncovered new challenges.
11
Refer to Chapter 7.
The SAFER guide is designed for self-assessment in nine areas to support organizations in the safer
use of EHRs.
Review the SAFER guide on the HealthIT.gov website and use the resources and tools to do a selfassessment of your place of work and share your results by answering the following questions:
1- any surprises in the results,
2- what areas of opportunities or improvements did the self-assessment produce,
3- name three things you would include in an improvement plan.
(www.healthit.gov/buzz-blog/electronic-health-and-medical-records/safer-guides-optimizesafety)
SAFER Guides will help optimize safety
Jacob Reider | JANUARY 15, 2014
After a lot of hard work, we have combined evidence-based guidelines with practical advice to
help you use your health information technology more safely. We’ve been working to post the
Safety Assurance Factors for EHR Resilience (SAFER ) Guides since we highlighted them in our
Health IT Patient Safety Action and Surveillance Plan last July.
There are nine SAFER Guides and each is designed to help care delivery organizations of all shapes
and sizes conduct self-assessments of recommended practices in those areas we know are
important to the safety and safe use of health information technology. The nine guides are:
High Priority Practices
Organizational Responsibilities
Patient Identification
CPOE with Decision Support
Test Results Review and Follow-up
Clinician Communication
Contingency Planning
System Interfaces
System Configuration
As a family physician who has worked for years on making sure that health information technology
is leveraged to improve the safety and quality of health care, I’m thrilled to see the SAFER Guides
fill a void: We’ve never before had a set of tools that care delivery organizations can use to
perform self-assessments and developer customized improvement plans.
There is good evidence that health information technology improves the safety of care, especially
when implemented using best practices. We’ve learned that there is a great deal of variability in
how information technology is implemented and optimized in care delivery organizations, and this
variability may account for some of the problems with the safety and reliability of health IT. These
guides help enhance the likelihood that health information technology is implemented in a
manner that aligns with best practices. For example, the SAFER Guide on Organization
Responsibility should help the leadership of health IT-enabled organizations monitor critical
components of the safety and safe use of health IT and make sure that a team of people –
including clinicians and safety staff within the organization, as well as health information
technology developers – is continuously engaged and focused on safety. The SAFER Guide on High
Priority Practices is designed to help organizations explore where they can start to integrate health
IT safety into their patient safety programs by identifying high-priority, high-risk practices
associated with health IT use, and then suggesting which other SAFER Guides might help.
The SAFER Guides on Contingency Planning (which focuses on avoiding and recovering from
downtimes), System Interfaces, and System Configuration should help organizations ensure that
the health IT is safely designed, maintained, and configured, is reliably available and that the
information therein is accurate and current within established expectations when each clinician
uses it to care for patients.
The SAFER Guides on Patient Identification, CPOE with Decision Support, Test Results Review and
Follow-up, and Clinician Communication will help practices establish systems that will allow them
to be more confident that vital clinical information on the right patient will successfully reach
clinicians who need it.
ONC and AHRQ, our partners in developing health IT safety tools, research, and education, will
reach out to organizations and associations to encourage wider use of the SAFER Guides. We hope
every sector of the healthcare industry will consider how they can make the SAFER Guides their
own, including tailoring the content to their particular setting, specialty, and priorities. We look
forward to feedback and hope everyone involved with health IT will consider how they can use the
SAFER Guides to work on what must be a fundamental commitment and priority – using health IT
to make patient care safer.
Please refer to the grading rubric. Submission must be at least 2 pages.
RUBRICA
Learning Activity Question
50% of total result
Excellent
The learning activity questions are answered comprehensively. The word count if applicable has
been met, and it is accurate, non-evaluative, coherent, readable, and concise. All the following
elements are included: a. The problem or issue you are presented and clearly explained, and b. the
author’s conclusions are clear and concise are explained. There is an introduction and a conclusion
to the submission.
50
Satisfactory
The learning activity questions are not answered comprehensively. The word count is 50 words
short of meeting the required count, and it is accurate, has some non-cohesive thoughts, readable,
and is concise. All the following elements are included: a. The problem or issue you are presented
and clearly explained, and b. the author’s conclusions are clear and concise are explained. There is
either an introduction or a conclusion to the submission- but not both.
37.5
Unsatisfactory
The learning activity questions are not answered comprehensively. The word count is 50 words
short of meeting the required count, but it is not clear and accurate, has some non-cohesive
thoughts, and struggles to be coherent, readable, and concise. All the following elements are
included: a. The problem or issue you is not presented and clearly explained, and b. the author’s
conclusions are not clear and concise are explained. There is either an introduction or a conclusion
to the submission- but not both.
25
Poor
The learning activity questions are not answered comprehensively. The word count is more than
50 words short of meeting the required count, but it is not clear and accurate, has some noncohesive thoughts, and struggles to be coherent, readable, and concise. All the following elements
are included: a. The problem or issue you is not presented and clearly explained, and b. the
author’s conclusions are not clear and concise are explained. There is NO introduction or a
conclusion to the submission.
Reference Page
25% of total result
Excellent
Utilizes at least 3 sources and all sources are current within 5 years. Cited following APA format.
25
Satisfactory
At least 1 of 3 sources are NOT current (within 5 years) but ALL are cited following APA format.
18.75
Unsatisfactory
Of the 3 sources used at least 2 sources are NOT current (within 5 years) and some are cited NOT
following APA format.
12.5
Poor
Does not use at least 3 sources and/or 3 sources are NOT current (within 5 years) and some are
cited NOT follow
•
Grammar, Spelling, APA
25% of total result
Excellent
Minimal spelling and/or grammar mistakes. APA format is maintained.
25
Satisfactory
Some spelling, APA, and/or grammar mistakes.
18.75
Unsatisfactory
Noticeable spelling, APA, and/or grammar mistakes.
12.5
Poor
An unacceptable number of spelling, APA, and/or grammar mistakes.
6.25
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