Health Information Technology through the Lens of Patient Safety

Health Information Technologythrough the Lens of Patient SafetySection 4. HIT Adoption andSystem Design1

Keys to Successful HITImplementation• Involving key stakeholders• Using human factors engineering anddeliberate system design2

Involving Key Stakeholders1. Identifying potential barriers2. Defining success3. Developing training3

1. Identifying Barriers• Develop an effective plan with end-usersupport• Solicit feedback from end users• Use evaluation process to identify potentialbarriers4

2. Defining Success• Involve key stakeholders in determiningvision and guiding principles• Ensure stakeholders’ role in establishinggoals5

3. Developing Training• Demonstrate the value to the end user• Show how HIT can improve patient safety andprotect the end user from causing harm• Use effective training to increase adoptionand safe use of newprocesses6

Using Human Factors Engineeringand Deliberate System Design• Make it easier to do the right thing• Make it harder to do the wrong thing• Reduce failure modes• Support safe, efficient, effective care• Support caregivers in decision making• Automate “routine” tasks7

Steps Related to System Design1. Determining the impact onworkflows2. Paying attention to key factors forcare delivery3. Analyzing the physical environmentand population served4. Establishing maintenance processes8

1. Determining Impact on Workflows• Ensure involvement of key stakeholders• Outline all steps in work processes• Identify strengths and weaknesses ofcurrent processes• Incorporate favorable processes intosystem design• Develop vendor specifications9

2. Paying Attention to Key Factorsfor Care Delivery• Integration• Deliberate design in workstations• Ease of use• Variations in practice• Cognitive impact• Location of input and retrieval devices10

Integration• Review policies and procedures for facilitylevelnormalization and standardization• Drive clinicians to computer for reliableinformation• Enable end user to access frequently usedinformation quickly11

Deliberate Design in Workstations• Use a mix of mobile and stationary workstations• Base number on maximum users at busiest time• Establish cleaning procedures, maintenanceprocesses, and equipment storage processes• Consider battery life and need for secure storagefor mobile devices• Consult guidelines concerning devices left inhallways for extended periods12

Ease of Use• Sync passwords• Base monitor size on optimal resolution andminimal scrolling• Locate point-of-useequipment close topatient locations13

Variations in Practice• Keep track of process changes, even if minimal• Implement major changes prior to systemimplementation• Avoid inserting technology on faulty processes14

Cognitive Impact• Consider possible loss of colleague supportduring charting• Avoid removing clinician’s need to understandlogic for reaching a conclusion• Develop an alert philosophy15

Location of Input and RetrievalDevices• Ensure a sufficient number of devices• Consider the need for eye contact• Consider the need for data display at thebedside16

3. Analyzing the Physical Environ-ment and Population Served• Conduct an environmental analysis of eachdepartment• Determine how the population is currentlyserved and how layout affects clinical processes• Evaluate roles and responsibilities of staff• Assess the population served and risks• Consider risk of harm from wires andequipment17

4. Establishing MaintenanceProcesses• Creating a preventative maintenance andreplacement program• Establishing a process for system changes,upgrades, and redesign18

Creating a Preventive Maintenanceand Replacement Program• Establish and communicate processes forplanned maintenance and replacements• Inventory equipment and assess devices• Ensure intradepartmental coordination• Consider timing of event to minimizedisturbance and risk of safety hazards• Plan longer scheduled downtimes during offhours19

Establishing a Process for SystemChanges, Upgrades, and Redesign• Select metrics and define success criteria• Ensure that metrics are reflective of systemgoals• Choose different metricsover time20

References• Chaudhry B, Wang J, Wu S, et al. 2006. Systematic review:impact of health information technology on quality, efficiency,and costs of medical care. Ann Intern Med. 144:742–752.• Elder KT, Wiltshire JC, Rooks RN, Belue R, Gary LC. 2010. Healthinformation technology and physician career satisfaction.Perspect Health Inf Manag. 7 pii: 1d.• Federal Aviation Administration (FAA). 2000. Human factorsengineering and safety principles and practices. In: FAA SystemSafety Handbook. Washington DC: Federal AviationAdministration.http://www.faa.gov/library/manuals/aviation/risk_management/ss_handbook/. Accessed Apr 11, 2012.21

References, cont.• Kohn LT, Corrigan JM, Donaldson MS, eds. 2000. To Err IsHuman: Building a Safer Health System. Institute of Medicine(IOM), Committee on Quality of Health Care in America.Washington, DC: National Academy Press.• Krause T, Dunn S. 2006. How are leadership and culturerelated to patient safety? Behavioral Science Technology, Inc.http://www.worldcongress.com/events/HR09000/pdf/thoughtleadership/bst/WhitePaper%20-%20How%20Are%20Leadership%20and%20Culture%20are%20Related%20to%20Patient%20Safety%20Mar%202007.pdf.Accessed Sep 15, 2011.22

References, cont.• Lucian Leape Institute (LLI). 2011. Health InformationTechnology and Patient Safety: A Dynamic Discussion.Proceedings of the Lucian Leape Institute at the NationalPatient Safety Foundation Third Annual Forum and Gala,Boston, MA, 2010. http://www.npsf.org/wp-content/uploads/2011/10/LLI_Forum-Gala2010_Proceedings_web.pdf. Accessed Apr 10, 2012.• McGowan JJ, Cusack CM, Poon EG. 2008. Formativeevaluation: a critical component in EHR implementation. J AmMed Inform Assoc. 15(3):297–301. Epub Feb 28, 2008.23

References, cont.• Walker J, Carayon P. 2009. From tasks to processes: the casefor changing health information technology to improve healthcare. Health Aff (Millwood). 28(2):467–477.http://content.healthaffairs.org/content/28/2/467.full.html.Accessed Jul 11, 2011.24

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