Spotlight on patient safety

With help from Arthur Allen (@arthurallen202) and Darius Tahir (@dariustahir)

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SPOTLIGHT ON PATIENT SAFETY: This month’s issue of Health Affairs featured several studies on patient safety. Here are a few of our takeaways:

Greater risk to kids: Poor EHR design can lead to medication errors, which can be especially detrimental for children whose body weights are lower and whose immune systems aren’t as developed as adults’. In more than a third of pediatric patient safety events involving EHRs and medication, the technology’s “usability” contributed to medication errors, according to one study.

For instance, one physician ordered five times the recommended dosage without getting an alert from the EHR, researchers found.

In about a fifth of those cases, the mistake — which could result in improper dosage or incorrect prescriptions — actually reached the patient, sometimes leading to temporary harm, according to the analysis of 9,000 safety reports.

Raj Ratwani — director of the National Center for Human Factors in Healthcare at MedStar Health and the study’s lead author — has urged ONC to publish a draft of a voluntary certification for EHRs used in pediatric settings; the 21st Century Cures Act directs ONC to create those criteria.

Researchers also argued that Congress should conduct oversight into ONC’s plan to create an EHR reporting program that could help customers compare products, ensuring that the agency is prioritizing patient safety.

—Why health systems should just ask patients what went wrong: Perhaps unsurprisingly, patient feedback can help physicians better understand their mistakes, researchers concluded in another study. After examining almost 200 patient narratives describing diagnostic error, researchers found 224 mentions of interpersonal and behavioral factors that could have contributed to the error — doctors ignoring patient knowledge or disrespecting patients, for instance.

Health systems have a rigorous process for analyzing diagnostic error, but it doesn’t often involve the patient’s own experience, said lead author Traber Giardina, a researcher at the Center for Innovations in Quality, Effectiveness, and Safety.

Giardina told Morning eHealth that hospital systems should establish an IT system that can gather patient feedback in a way patients feel is convenient, such as a mobile app.

“Right now, there are no good ways to get data electronically from patients except maybe patient experience surveys,” said Hardeep Singh, a researcher and medical professor at Baylor University.

Once health systems gather more patient narratives, they could use natural language processing and sentiment analysis to quickly look for factors that could have led to diagnostic error, Singh added.

There might even be hints about diagnostic error buried within common patient complaints about parking, temperature and food, Singh said. “In their narrative, did they really talk about a misdiagnosis?”

Real-time warnings: Researchers have piloted a way of monitoring EHRs to detect safety risks to hospitalized patients in real time. Pascal Metrics says it is the first organization to apply machine learning to a dataset of EHR-based adverse event outcomes.

The system, which Pascal tested at two community hospitals, can detect patient harm from real-time data and fires triggers that result in patient safety monitoring.

“This appears to be a genuine pivot away from retrospective reviews of patient safety incidents to real-time analysis,” said Jeff Smith, vice president for public policy at the American Medical Informatics Association.

While the study demonstrates the potential for use of real-time data, there were many false positives triggered by the system, noted Dean Sittig, a professor of bioinformatics at the University of Texas Health Sciences Center in Houston.

Until EHR systems become capable of limiting these false alarms, “systems like these will be untenable for all but the highest-staffed facilities,” Sittig said. Pros can read the rest of the story on the studies here.

eHealth Tweet of the day: Micky Tripathi @mickytripathi1 An app company commenting today on the rapid adoption of #FHIR called it “so transformative that we believe it will be a challenge to sell new health IT solutions that are not SMART-on-FHIR enabled” @hl7 #amia2018 @SMARTHealthIT

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VA EHR HEARING SET FOR NEXT WEEK: The House Veterans’ Affairs subcommittee overseeing the VA’s Electronic Health Record Modernization will hold a hearing next Wednesday to review the first 180 days of the Cerner contract, Morning eHealth’s Arthur Allen reports. Ranking Member Tim Walz noted recent reporting by POLITICO and ProPublica on problems and infighting at the VA that imperil the success of the project. Pros can read the full story here.

SUPREME COURT DECLINES TO TAKE NET NEUTRALITY CASE: The court battle over now-repealed Obama-era net neutrality rules ended with the Supreme Court declining to take the case.

According to a court order, Justices Clarence Thomas, Samuel Alito and Neil Gorsuch would have vacated a 2016 D.C. Circuit Court opinion upholding the regulations, which banned the blocking, slowing or paid prioritization of web traffic.

But Chief Justice John Roberts and Justice Brett Kavanaugh “took no part in the consideration or decision of these petitions,” denying challengers the conservative majority they needed to take the case and reverse the lower court decision.

Telemedicine advocates have argued that the repeal of net neutrality regulations could limit patients’ and providers’ access to virtual treatment.

RESMED BUYS EHR COMPANY MATRIXCARE: Respiratory device company ResMed acquired EHR vendor MatrixCare for $750 million, MobiHealthNews reports.

ON TAP TODAY: Nemours Children’s Health System hosts a webinar on technology and care coordination,11 a.m. EST.

—ICYMI: The New York Times reportson the VA’s hospital rating system and how it could hurt patients

—Rock Health’s new report on substance use disorder technology

—A study publishedin JAMA finds a link between community intervention programs and reduced readmissions