Patient Safety

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Patient Safety Clinical QualityInformation
Technology at THR

• Internal Medicine Update
• Presbyterian Hospital of Dallas
• October 29, 2003

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Overview

• Case study (Cleary 2003)
• Quality (IOM 2001)
• Safety (Bates 2003)
• Projects NOVA (IOM 2003)
• Key Success Factors (Berwick 2003)

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Case Study

• Cleary (200313833-39)
• A Patients Perspective on Quality

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Case Study

• Cleary (200313833-39)
• Admission experience
• Postoperative experience
• Teamwork failures
• Pain management
• Discharge services

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Crossing the Quality Chasm

• IOM (2001)
• Information technology hasenormous potential to
  improve thequality of health care

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Crossing the Quality Chasm

• IOM (2001)
• Safety
• Effectiveness
• Patient-centered
• Timeliness
• Efficiency
• Equity

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Efficiency and Timeliness

• Case study PACS and voice recognition technology

Ted Wen MD, RadiologyPresbyterian Hospital of
Plano
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IT and Patient Safety

• Bates and Gawande (2003 3482526-2534)
• Prevention of errors and adverse events
• Facilitating a more rapid response to adverse
  events
• Tracking and providing feedback about adverse
  events

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IT and Patient Safety

• Bates and Gawande (2003 3482526-2534))
• Improve communication
• Access to knowledge
• Require key information
• Assist with monitoring
• Provide decision support

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Communication

• Case study electronic messaging

Ed Goodman MD, Infectious DiseasePresbyterian
Hospital of Dallas
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Communication
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Access to Knowledge

• Case study medical references and clinical data

Robert Lilli MD, Family PracticeHarris Methodist
Fort Worth Hospital
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Access to Knowledge
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Assist with monitoring

• ICU monitoring
• Fetal monitoring

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Decision Support
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Decision Support

• Case study Weight based dosing for intravenous
  unfractionated heparin
• Rashke et al (1993119874-881)

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Impact of Decision Support

• Compliance with weight-based dosing for Heparin
• pre-CPOE 15
• post-CPOE 85

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Projects NOVA

• Infrastructure
• Mainframe
• Network
• Common desktop
• Interface engine
• Applications
• Surgical management and scheduling
• Laboratory information system
• Physician portal (CareGate)

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Projects NOVA Applications

• Clinical documentation
• Orders management
• Medication management

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Selection Methodology

• NOVA Advisory Board
• IOM Report Key Capabilities of an Electronic
  Health Record System (2003)
• THR functional requirements
• Vendor evaluations

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Information Services

• National recognition

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Challenges

• Cultural
• Administrative
• Technical

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Change Leadership

• Berwick (2003 2891969-1975)
• Find sound innovations
• Find and support innovators
• Invest in early adopters
• Make early adopter activity observable

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Change Leadership

• Berwick (2003)
• Trust and enable reinvention
• Create slack for change
• Lead by example

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Discussion

• Roles of allied health professionals
• Achieving consistency of clinical practice (e.g.,
  formulary, order sets)
• Using decision support to influence clinical
  practice
• Medical staff by-laws

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Bibliography

• Cleary PD Ann Intern Med. 200313833-39
• Institute of Medicine. Crossing the Quality
  Chasm A New Health System for the 21st Century.
  Washington, DC National Academy Press 20011
• Bates DW and Gawande AA N Engl J Med 2003
  3482526-2534
• Institute of Medicine. Key Capabilities of an
  Electronic Health Record System. Washington, DC
  National Academy Press 20031
• Berwick DM JAMA 2003 2891969-1975

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Presenter Contact Information

• Ferdinand Velasco, MD
• Chief Medical Information Officer Texas Health
  Resources 601 Ryan Plaza Dr., Suite 301
  Arlington, TX  76011 [phone] E-mail
  FerdinandVelasco_at_texashealth.org