“Eventually, better systems are really going to improve patient care.”
Dr. Schneider hopes the guides be- come a popular tool among physicians, but he says it’s too early to tell how ef- fective they will be. “They won’t take care of everything, but if they can help you avoid one or two major problems, then the time peo- ple spend looking at them is probably worth their weight in gold,” he said. “In my years of using EHRs, I’ve selected the wrong form of medicine more than once because of poor EHR design.” Dr. Schneider says typographical er-
“SAFER guides help us anticipate and deal with consequences,” Dr. Singh said. “The goal is to develop guidelines for the front lines.”
A team approach Each SAFER guide includes a recom- mended practice checklist that you can download and use to assess a practice’s EHR system safety components. For ex- ample, a checklist item might say, “The status of orders can be tracked in the system.” The user can rate the item as fully, partially, or not implemented, de- pending on the EHR’s capability. If the practice has not fully imple- mented orders tracking in the system, or if the user is unsure, an accompany- ing Recommended Practice worksheet provides guidance on the importance of tracking orders and suggestions for resources to provide more information about it.
Clinicians can save the Recommend- ed Practice worksheet for further review and forward it to others. (See “Practice Makes Perfect,” opposite page.) The authors of the SAFER guides —
Dr. Singh; Dean Sittig, PhD; and Joan Ash, PhD — recommend setting up a multidisciplinary team for each of the nine guides to evaluate which of the rec- ommended practices are already being done and which practices need to be im- plemented to strengthen patient safety. For example, Dr. Singh says, the Test
Results Reporting guide team could consist of one or more clinicians, infor-
36 TEXAS MEDICINE June 2014
mation technology staff, lab personnel, practice leaders or administrators, and an EHR vendor. Dr. Singh says it is important to have meaningful conversations on safety with all the stakeholders involved, including EHR vendors.
After completing the checklist in each guide, the multidisciplinary team can use the Team Worksheet included in each guide to document its assessment. The Team Worksheet allows the group to assign a team leader; identify team members and their roles; record the self- assessment completion date; and add notes about considerations, conclusions, pending software updates, and more. Small practices should start with the High Priority Practices guide, which poses questions about computer down- time, backup availability, and procedures to ensure correct patient identification. Practices can then see which EHR safety hazards need to be addressed immedi- ately, Dr. Singh says. After users review the High Priority
Practices guide, they can complete the remaining guides in order of where pa- tient safety risks are likely to occur in the system, he says.
The grand challenge Dallas pediatrician Joseph Schneider, MD, chair of TMA’s Council on Practice Management Services, says physicians must select an EHR system carefully and use the SAFER guides to make sure they implement the system correctly.
rors are easy to make in EHR systems and can be hard to correct. For example, he says, a staff member might intend to enter a premature infant’s weight as 4.1 pounds but forget the decimal and enter 41 pounds. The bad data might not be noticeable until weeks or months later, perhaps when the growth chart shows a spike where one should not exist, he says. By then, it might be too late to change the data.
“In the paper world, you would nev- er write ‘41 pounds’ for a two-month- old,” he said. “Not all systems are clever enough to alert you that you can’t have a 41-pound two-month-old.” But most EHR systems are not capa- ble of summarizing patient information or suggesting treatments to better aid physicians, says Dr. Sittig, a professor at The University of Texas School of Bio- medical Informatics.
“That’s what I call a grand challenge.
That’s what computers are supposed to be able to do,” he said. According to “Electronic Health
Records and National Patient-Safety Goals,” a 2012 New England Journal of Medicine article by Drs. Sittig and Singh, the number of certified EHR vendors in the United States increased from 60 in 2008 to more than 1,000 in 2012. The article says many vendors focus on using EHR technology to achieve meaningful use requirements instead of focusing on patient safety. Dr. Sittig says EHRs are a relatively new form of technology. Ultimately, he hopes EHRs will be able to recommend treatments for individual patients, much like Amazon can suggest books based on what the customer has already read. “The first thing we have to do is get
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