February 09, 2010, MGH, Swaziland

1. The Conference on Patient Safety & Integrated Health Records Practical Approaches to development of patient safety information systems Chien-Tsai Liu, Professor Graduate Institute of Biomedical Informatics, Taipei Medical University February 09, 2010, MGH, Swaziland

2. Patient safety definitions Narrowly: the issues specifically related to adverse events and their prevention Broadly: any aspect of healthcare and health services that may lead to patient injury, and any interventions, including clinical, organisational and policy changes that aim to reduce injury Patient safety is now one of the most important issues in healthcare internationally through the initiative “World Alliance for Patient Safety” led by the World Health Organisation (Oct. 2004 )

3. A Venn diagram of Patient safety definitions Adverse Events Medical Errors No harm events Preventable events Negligence Near Misses Sentinel Events 財團法人醫院評鑑暨醫療品質策進會 http://www.tjcha.org.tw/

4. Deaths associated with medical errors

5. 5 elements for improving Patient safety • A ‘just’ or ‘fair’ culture that encourages a reporting and questioning culture that is complemented by systems for reporting and analysing incidents both locally and nationally. • A good in depth analysis process to establish root causes for selected individual incidents and aggregate incident reviews which enables learning. • A process to ensure that actions are implemented, and corresponding improvements in patient safety and quality of care can be demonstrated. • Effective processes for sharing information at various levels - nationally, organisationally and clinically - for learning and improvement. • A redefinition of both punitive and non-punitive compensation systems in the healthcare environment, and an assessment of their impact on the patient safety culture and its achievements.

6. Major causes of medical errors &adverse events

7. Major causes of medical errors &adverse events • Incomplete or missing information • Many adverse drug events could be avoided if healthcare providers had more complete information about which drugs their patients are taking and why • Lack access to patients’ complete medical history. • Organizational factors • Deficiencies in system design, organization and operation, including an organization’s strategy, its quality management tools, and its capacity to learn and adapt

8. Main strategies for preventing medical errors and adverse events using IT • Tools to improve communication • Making knowledge more readily accessible • Assisting with calculations • Performing checks in real time • Assisting with systemic checking & monitoring • Providing decision support Bates and Gawande, NEJM 2003

9. IT in healthcare applications: a review • Decision Support Systems • Computerized Physician Order Entry • Adverse event systems & alert systems • Electronic Medical Record (EMR) • Incident reporting systems  ICT systems can lead to considerable benefits in patient safety only if they are user-friendly and fully integrated with other relevant systems.

10. HAI surveillance systems: an example  Hospital acquired infection (HAI) surveillance is a systematic, ongoing data collection, analysis and reporting process that quantitatively monitors temporal trends in the occurrence and distribution of susceptibility and resistance to antimicrobial agents, and provides information useful as a guide to medical practice, including therapeutics and disease control activities. . •  A HAI surveillance system features: • Multiple systems involved • Integrated work & information flows; • Decision support; Monitoring & Alerts; Reporting

11. UTI Risk factors extracted from EMRs LIS : Laboratory information system; IMS: Inpatient management information System PMS: Medication management information system; CPOE: computerized provider order entry

12. The framework of HAI surveillance system RIS (Radiology images reports) LIS (Culture orders & results) IMS (patient admission data ) CPOE (diagnosis & orders) NRS (care plan &drug administration) Other EMRs Interconnected secure networks Alerts & reporting management Data collection & integration engine Msg delivery HAI surveillance database Analysis, visualization & presentation Early detection of infected cases & clusters (DSS)

13. Integrated patient profiles based on the CDC guidelines Selection of risk predictors Refresh patients information Dashboard for summary of patients’ infection information Red: positive/yes; green: negative/no

14. Click a specific patient to view his detailed admission data

15. Decision support: Algorithms for detection of suspected HAI cases Discrimination functions demonstrate high sensitivity ( 99.25%) & Specificity ( 94.92 %)

16. the confirmed cases can be exported to the excel files for further analysis

17. The confirmed cases can be linked to CDC’s reporting system.

18. Summary • IT systems in healthcare applications have shown the effectiveness in reducing the number of advent events, and improving practitioner performance. • The systems also could introduce or facilitate new types of errors (information errors and human-machine interface flaws) • Evidence-based evaluation methods for evaluating such safe systems are critical.

19. Summary (2) • Evidence-based evaluation methods for evaluating such safe systems are critical. Phase 1: a systematic review of the health informatics literature involving technology-facilitated or technology-induced error. Phase 2: reviewing the literature and generating a comprehensive heuristics that could be used to evaluate an HIS for technology-induced errors. Phase 3: conducting evaluation of the system using evidence-based heuristics Healthcare quarterly Vol. 12 Special issue 49-54: Ensuring the safety of health information systems: using heuristics for patient safety

20. Thank you 謝 謝 !! Chien-Tsai Liu TEL: +886-2-27361661 # 3342 Email: ctliu@tmu.edu.tw