Driving Change Through Collaboration: The Partnership for Health IT Patient Safety 2020 Projects
TimeFriday, April 162:40pm - 3:00pm EDT
LocationPatient Safety Research and Initiatives
DescriptionDuring 2020, the Partnership focused on the following extensive workgroup projects and the development of safe practice recommendations. One of these two workgroups was work conducted again in collaboration with HIMSS EHR Association. Information and materials developed from each of the 2020 workgroups will be discussed. The whitepapers, safe practice recommendations and implementation strategies, and other related content will be shared.
• Optimizing Health IT for the Safe Integration of Behavioral Health and Primary Care (EHRA/ECRI Workgroup)
• Safe Practices to Reduce CPOE Alert Fatigue through Monitoring, Analysis, and Optimization (ECRI Workgoup)
Optimizing Health IT for the Safe Integration of Behavioral Health and Primary Care
“Integration” of behavioral health and primary care has been identified as a promising approach to achieving enhanced patient care and improving patient safety as well as care quality and clinical outcomes. As with other aspects of healthcare, technology-enabled tools, including electronic health records (EHRs), clinical decision support (CDS), and standards-based interoperability, can enhance the ability of integration to achieve these goals. EHRs are the primary health IT tools used in primary care practices1 but are not implemented as widely or often in the same manner in behavioral health settings. To date, most EHRs have not been designed specifically to support integrated behavioral health and primary care.1 To enable integrated care, and to realize the potential of technology, EHR functionality must keep pace and incorporate information (e.g., screening and documentation), CDS, and the interoperability needs of integrated behavioral health and primary care models.2
The safe practice recommendations focus on technology’s role in screening, documentation, and sharing of information to optimize the integration of behavioral health and primary care. The Partnership/EHRA workgroup synthesized the findings from the data analysis, the evidence-based literature review, and the
workgroup’s own deliberations to craft the recommendations.
• Ensure that validated, clinically accepted screening tools are integrated, easily accessible, and readily
available in the EHR.
• Enable triggers for CDS associated with screening tools to integrate behavioral health and primary care.
• Optimize documentation to support integration of behavioral health and primary care.
• Enable information sharing across care environments (within organizations, among clinicians in the same system, or across organizations and systems) and with portals, secure messaging, and HIEs.
• Enable EHRs to use information in the record to segment patient information for exchange consistent with organizational policies, patient requests, and state and federal laws and regulations.
Safe Practices to Reduce CPOE Alert Fatigue through Monitoring, Analysis, and Optimization
Technology and its associated tools, in particular clinical decision support (CDS) alerts, have produced both benefits and unanticipated consequences. While alerts can facilitate patient safety, they may also contribute to alert fatigue and clinician burden. Burden is associated with over alerting and with inappropriate, ineffective, and nonspecific alerts.3 With the increase in patient parameters to monitor, informational reminders, and alerts associated with outside data, the need increases to identify effective mechanisms to monitor, analyze, optimize, and govern alerts. The rationale for addressing this issue is to ensure that the persons most impacted—the end users of the technology—receive correct and timely information at the right point in the patient's care while minimizing the interruption and volume of alerts.
The group proffered four safe practice recommendations, related to the following areas:
1. Governance: Identify, develop, and execute a CDS and knowledge base governance plan.
2. Monitoring: Gather data and information using CDS-specific metrics and other tools to identify real-time and/or near real-time CDS alert functioning and impact.
3. Analysis: Regularly assess, evaluate, and interpret metrics, functionalities, usability, and impact to determine effectiveness and value while balancing and minimizing burden.
4. Optimization: Maximize the use of technology and various tools to create and promote effective, targeted, relevant, and routinely updated alerts.
The four safe practice recommendations offered in this report are interwoven and do not follow a linear progression. Rather, the steps involved in monitoring, analysis, and optimization are cyclical and often overlapping. But in order to execute each of the steps and processes associated with monitoring, analysis, and optimization, a comprehensive governance plan is important.
1. Price-Haywood EG, Dunn-Lombard D, Harden-Barrios J, et al. Collaborative depression care in a safety net medical home: facilitators and barriers to quality improvement. Popul Health Manag. 2016 Feb;19(1):46-55. Also available: https://dx.doi.org/10.1089/pop.2015.0016. PMID: 26087153.
2. Institute of Medicine, Committee on Quality of Health Care in America. Corrigan JM, et al, editor(s). Crossing the quality chasm: a new health system for the 21st century. Washington (DC): National Academy Press; 2001. 337 p. Also available: http://search.nap.edu/books/0309072808/ html/.
3. Jankovic I, Chen JH. Clinical decision support and implications for the clinician burnout crisis. Yearb Med Inform. 2020 Aug;29(1):145-54. Also available: http://dx.doi.org/10.1055/s-0040-1701986. PMID: 32823308.