optimizing emr workflow to reduce medical errors & physician frustration
TRANSCRIPT
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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.
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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).
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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.
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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.
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5RSQ® Solutions
5RSQ® Solutions
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6RSQ® Solutions
6RSQ® Solutions
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7RSQ® Solutions
7RSQ® Solutions
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8RSQ® Solutions
8RSQ® Solutions
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9RSQ® Solutions
9RSQ® Solutions
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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
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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.
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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.
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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
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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."
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15RSQ® Solutions
15RSQ® Solutions
Factors Affecting Physician Professional Satisfaction and Their Implications for Patient Care, Health Systems, and Health Policy (2013)
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16RSQ® Solutions
16RSQ® Solutions
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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.
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18RSQ® Solutions
18RSQ® Solutions
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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
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20RSQ® Solutions
20RSQ® Solutions
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21RSQ® Solutions
21RSQ® Solutions
Leading Causes of Death in U.S.
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22RSQ® Solutions
22RSQ® Solutions
Used with permission from and art by Caroline Laplante http://claplante.blogspot.ca/
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23RSQ® Solutions
23RSQ® Solutions
A PromiseUnfulfilled
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24RSQ® Solutions
24RSQ® Solutions
Time For AChange!!
A PromiseUnfulfilled
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25RSQ® Solutions
25RSQ® Solutions
Human Factors Engineering
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26RSQ® Solutions
26RSQ® Solutions
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27RSQ® Solutions
27RSQ® Solutions
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28RSQ® Solutions
28RSQ® Solutions
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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.
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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.
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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.
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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.
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33RSQ® Solutions
33RSQ® Solutions
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34RSQ® Solutions
34RSQ® Solutions
Data from CRICO-2011 EM Analysis
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35RSQ® Solutions
35RSQ® Solutions
Data from CRICO-2011 EM Analysis
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36RSQ® Solutions
36RSQ® Solutions
Data from CRICO-2011 EM Analysis
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37RSQ® Solutions
37RSQ® Solutions
Data from CRICO-2011 EM Analysis
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38RSQ® Solutions
38RSQ® Solutions
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39RSQ® Solutions
39RSQ® Solutions
Vital Sign Solution
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40RSQ® Solutions
40RSQ® Solutions
Vital Sign Solution
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41RSQ® Solutions
41RSQ® Solutions
Vital Sign Solution
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42RSQ® Solutions
42RSQ® Solutions
Extremity Lacerations
What do we miss? Vascular injury Neurologic injury Tendon injury
Why? Because we are human!
The solution?
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43RSQ® Solutions
43RSQ® Solutions
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44RSQ® Solutions
44RSQ® Solutions
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45RSQ® Solutions
45RSQ® Solutions
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46RSQ® Solutions
46RSQ® Solutions
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47RSQ® Solutions
47RSQ® Solutions
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48RSQ® Solutions
48RSQ® Solutions
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49RSQ® Solutions
49RSQ® Solutions
The HPI Must Talk to the Review of Systems
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50RSQ® Solutions
50RSQ® Solutions
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51RSQ® Solutions
51RSQ® Solutions
The Entire Medical Record Should Talk to Medical Decision Making
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52RSQ® Solutions
52RSQ® Solutions
The HPI and PE Should Talk to Medical Decision Making
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53RSQ® Solutions
53RSQ® Solutions
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54RSQ® Solutions
54RSQ® Solutions
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55RSQ® Solutions
55RSQ® Solutions
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56RSQ® Solutions
56RSQ® Solutions
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57RSQ® Solutions
57RSQ® Solutions
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58RSQ® Solutions
58RSQ® Solutions
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59RSQ® Solutions
59RSQ® Solutions
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60RSQ® Solutions
60RSQ® Solutions
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61RSQ® Solutions
61RSQ® Solutions
HR = 120
POx = 92%
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62RSQ® Solutions
62RSQ® Solutions
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63RSQ® Solutions
63RSQ® Solutions
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64RSQ® Solutions
64RSQ® Solutions
Nurse Enters Birth Weight on an Infant
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65RSQ® Solutions
65RSQ® Solutions
If the child is less than 60 days of age, the program asks for a current weight
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66RSQ® Solutions
66RSQ® Solutions
Neonatal Auto Weight Calculator with Alerts
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67RSQ® Solutions
67RSQ® Solutions
Neonatal Auto Weight Calculator with Alerts
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68RSQ® Solutions
68RSQ® Solutions
Neonatal Auto Weight Calculator Alert
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69RSQ® Solutions
69RSQ® Solutions
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70RSQ® Solutions
70RSQ® Solutions
Syndrome Surveillance
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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)
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72RSQ® Solutions
72RSQ® Solutions
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73RSQ® Solutions
73RSQ® Solutions
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74RSQ® Solutions
74RSQ® Solutions
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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!
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76RSQ® Solutions
76RSQ® Solutions
Questions?
Please contact Brant Roth at [email protected] for information about TSG’s RSQ® Solutions.
Please contact your Bermuda brokers for more information about the XL Catlin-TSG partnership.
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Thank You