• Re-engineering patient safety through EHR, health IT

    Author | Date November 26, 2012
    The healthcare industry has received advice from other industries for its use of information technology, namely IT innovators in finance and business. According to the Corporate Director for Global Healthcare Initiatives at Lockheed Martin, Robert Szczerba, PhD, you can add engineering to the list. During the first of three webinars through the Institute for Health Technology Transformation (iHT2), “Re-engineering Healthcare: Revolutionizing Healthcare with Aerospace Technology,” Szczerba emphasized the similarities and differences between aviation and healthcare.
    While both industries strive to ensure the safety of their stakeholders, they differ significantly in terms of the measures they have taken to integrate and update their safeguards. A major obstacle and cause for concern in healthcare is its cultural approach to monitoring safety hazards. With new incentives aimed at promoting the adoption of EHRs, this culture if left unchanged could hinder the ability of the systems to improve care delivery and patient outcomes. “How do you introduce new technologies and new capabilities into a system where there’s a culture of fear, a culture of not speaking up?,” posed Szczerba in response to findings that 58% of healthcare employees fear speaking up about safety problems.

    Credit: iHT2/Lockheed Martin

    By this point, nearly everyone working in and around healthcare understands that its approach to and use of safety via IT is antiquated. How antiquated? In comparison to aviation, there’s a difference of seventy years between when it and healthcare implemented checklists, 1934 and 2004 respectively. Searching for an explanation, Szczerba pointed to the potential of incentives. In this case, the pilot’s stake is the same as the passenger’s, personal (i.e., his own life).
    So what can healthcare learn from aviation to improve the situation? The answer lies in continuous process improvement: analytics > simulation > systems integration > healthcare delivery. “The continuous process improvement cycle allows for evidence-based/design, operations, and decision support,” noted the presenter. By repeating this cycle, patients should become the greatest beneficiary of policies and procedures that seek improvement while mitigating risk. As Szczerba observed, the first phase of the cycle entails much more than simply gathering data:
    Analytics isn’t just understanding the data that you have, it’s also understanding the data that you don’t have, understanding where the gaps are and what you need to procure or what you need to get to fill those gaps.  Once you have that data, you can then pinpoint where your problems are in your organization.
    At this point in time, the challenge for those in the healthcare industry is collecting data and staving off criticisms that progress isn’t being made quickly enough. In light of recent Congressional inquiries into the EHR Incentive Programs and Stage 1 Meaningful Use, Szczerba’s recognition of the pace of progress is exceedingly pertinent:
    Healthcare is really in the data collection phase. There’s so much press out there about EMRs . . . not working or being a pain. But what these are are just the early steps. These are simply data collection tools right now, and in defense and aerospace they’ve moved beyond that and actually gone to more information processing. So once you collect the data, you have to fuse the data and figure out which data is actually meaningful and which isn’t, what’s your confidence level in that data, and then how do you use that data to get information to the right person at the right time to make a decision. While there’s so much criticism out there about EMRs, it really is the first of a necessary sequence of steps that has to happen before you get to intelligent information processing.
    While drawing parallels between the two industries does offer some shortcomings, the analogy does shed light on the importance of gathering the right kinds and amount of information for stakeholders to identify the best path forward. And considering how safe flight is today versus yesteryear, the healthcare industry should be willing to suffer the comparison.
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    2 Responses to Re-engineering patient safety through EHR, health IT

    1. Keith Butler says:

      Our recent AMIA panel made the same point. To view the AMIA-Boeing video: http://www.youtube.com/watch?v=TW8JifrBJPw&feature=youtu.be

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