The role of HIT and its impact on Patient Care and Safety
In a world, that is constantly changing and evolving, customer expectations never remain the same. Pandemic is a recent example of it. All industries were affected badly by it but worst of all remained Healthcare. Providers, healthcare workers, and patients all had to prepare and embrace new ways to dealing with the situation where personal contact was considered fatal. Telehealth rescued providers and enabled patients to have access to doctors from the comfort of their homes. Technology and Connected Care has nudged hospitals to automate workflows, extend healthcare services beyond the four walls of the hospital. It has improved the processes that were time taking and looked impossible earlier.
The facilities, providers, hospitals, and health enterprises of today demand robust and flexible healthcare IT solutions that not only meet today’s requirements but also prepare them for tomorrow’s opportunities. HIT is defined as “the application of information processing involving both computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and decision making.”
HIT plays a significant role in Care settings and it impacts patient care and patient safety. A Congressional Budget office study stated that EHRs can reduce prescription errors by 95%. Furthermore, last decade saw the adoption of EHR in a major way, across the world. This has led to the major shift, the migration from paper records to EHR has benefitted providers, payers, and patients in many ways. There is no need for searching the paper records, copy and faxing records to other hospitals and providers; make phone calls to discuss the patient’s condition during an emergency, or before inter and intrastate transfers. With advanced EHR, it is easy for the provider to transfer patient data to the other providers instantly.
The Internet of Healthcare Things (IoHT) and HIT play a vital role in preventing errors, saving time, safety, and alerts. HIT encompasses various technologies ranging from simple charting, advance decision support, and integration with medical technology. HIT presents enormous opportunities for transforming healthcare, some of the examples include
- Minimizing human errors
- Improving clinical outcomes
- Facilitating care coordination
- Improving practice efficiencies
- Tracking & analyzing data
Computerized physician’s orders & E-prescribing (CPOE)
Computerized physician order entry implies the use of electronic, computer, or mobile device platform support to enter physician’s order including medication orders. CPOE were originally designed to improve the safety of medication orders, however the modern systems support additional features including electronic ordering of the tests, procedures, and consultation as well. CPOE is integrated with clinical decision support (CDS) which functions as an error prevention tool by guiding the prescriber on the preferred drug doses, route, and frequency of administration. Modern systems also contain features that assist the prescribers, for example – prompt for patient allergies, drug-lab interactions, and with advanced systems, prescribers get prompt towards an intervention for prescription based on clinical guideline recommendation. A meta-analysis cited in NCBI examining the effectiveness of CPOE towards reducing medication errors & drug events in hospitals stated that the system implementing CPOE with clinical decision support resulted in significantly minimizing medication errors (RR:0.46; 95% CI 0.31 to 0.71) and adverse drug reactions (RR: 0.47; 95% CI 0.35 to 0.60). Furthermore, studies conducted on community-based outpatient services also showed results in minimizing medication errors. A few instances of Hard Stops (a process that stops the progress of prescribing, dispensing or administering a medication that would be hazardous to a patient, it blocks the execution) had been examined and it was noted to be effective in changing prescribing errors. It is also observed standalone CPOE without CDS support doesn’t minimize medication errors.
Clinical Decision Support
Clinical Decision Support (CDS) provides healthcare teams with patient-specific information that enhances healthcare team and physician’s decision to provide better Patient Care. This information is rationally filtered and presented to the team at right time. CDS comprises a range of tools that are designed to enhance a physician and care team’s efficiency and enhance clinical workflow. The tools include notifications, reminders, and alerts for care providers and physicians, condition-specific order sets, patient-specific clinical summaries, documentation templates, investigation & diagnostic support, etc. Earlier, umpteen cases were reported where clinical staff forgot to take vitals or give medicines to the patients. A physician couldn’t make an informed decision about a patient’s allergies without the prompts and alerts which affected Patient Care. A Cochrane systematic review found that the use of on-screen reminders for physicians led to minor to modest improvements in process adherence, medication ordering, laboratory ordering, and clinical outcomes. A study conducted in Boston examined 18,115 drug alerts and noted that 33% of alerts were ignored by ordering physicians. Other clinical trials that examined the effect of different CDS system modifications that are designed to improve physician’s compliance to alerts have observed that “tiering” and “automation of alerts” led to improved physician’s compliance to CDS alerts. Other meta-analysis studies found that CDS systems that required healthcare providers to give the justification for overriding CDS advice were more likely to improve patient outcomes than the CDS system that just offered plain advice. Published research has consistently stated CDS system improve the quality of care and patient safety. However, the result may vary depending on the system’s design & utilization, and implementation method.
Electronic sign-out and hand-off tools
Electronic sign-out or ‘hand over’ are important for interstate and intrastate transfer of the patient. This communication pertains to passing patient-specific information from one care provider to the other, from one care team of the hospital to the next, or from care-providers to the patient’s family with a purpose to ensure care continuity and patient safety. One of the leading causes of sentinel events in the US is found to be breakdown in handover of Patient information. Electronic sign-out applications are tools either used as standalone or integrated with EMR to ensure a structured transfer of Patient information during ‘transfers’ or healthcare providers ‘handoffs’. Studies evaluating outcomes of electronic tools supporting shift-to-shift handoffs observed utilizing electronic sign-out tools resulted in fewer omission of critical patient information, and reduction in time taken to handover details that helped in arriving at better Patient outcomes.
Bar code medication administration (eMAR)
Bar code medication administration systems refer to electronic systems that integrate Electronic medication administration record (eMAR) with bar code technology. These systems are designed to prevent medication errors by ensuring that the right patient gets the right medication at the right time. Advance software also give out alerts in cases where sound-alike or look-alike medications get confused. Others provide clinical advisories for specific medications when scanned, documentation assistance – for example recording drug administration in the eMAR and relevant clinical details. The systematic review of quasi-experimental studies has reported integrating bar code medication administration with eMAR has led to 50 to 80% reduction in medication administration errors. These studies were conducted in an in-patient adult setting.
In the 2016 Infusion Nurses Society (INS) Infusion Therapy Standards of Practice, a smart pump is defined as an “electronic infusion device with imbedded computer software aimed at reducing drug dosing errors through the presence and use of a drug library.” The software alerts the operator, when the infusion settings exceed or, is set outside of pre-configured safety limit. The systematic review of quasi-experimental studies has concluded that smart pumps may reduce programing errors but they do not eliminate such errors. The review also observed that hard limits were more effective than soft limits in preventing medication errors.
Automated Medication Dispensing Technology (ADC)
Automated medication dispensing cabinets (ADC) are drug storage cabinets that store medication at the point of care and provide computerized control for dispensing & tracking of medication distribution. ADC was first introduced in late 1980 in hospitals. This decentralized medication distribution evolved during past years and have added more sophisticated softwares and digital interfaces to combine high-risk steps in the medication dispensing process. ADCs have been utilized as a medication inventory management tool that automates the medication dispensing process by reducing the workload on the central pharmacy and tracking of medication and monitoring medication dispensing and patient billing. It is to be noted that there is only one study (published controlled trial) that found that the use of ADC led to 28% reduction in the rate of medication errors in hospital critical care unit.
Patient Electronic Portal
A Patient portal is a website that allows Patients’ secure convenient access to their personal records 24 x 7 via web or mobile. It facilitates two-way communication for the patients with their providers. Numerous studies have demonstrated that patient portals improve outcomes of Preventive Care, disease awareness, and self-management.
Telemedicine refers to the provision of remote clinical services provided by utilizing electronic information and telecommunication technology. It facilitates two-way communication between the patient and the provider. Synchronous telemedicine refers to real-time, two-way communication through video. Asynchronous telemedicine refers to (store and forward) transmission of a patient’s data to a provider.
It refers to a virtual visit or a real-time consultation with a physician or care provider via two-way audio/video communication through video conferencing. One of the successful examples of Synchronous telemedicine is during the Pandemic. People across the world have embraced virtual consultation as stepping outside or visiting a hospital could lead to getting infected by the virus. The COVID-19 has accelerated the utilization of digital health dramatically. Many parts of Europe, the US, and Asia reported a reduction in Emergency Department visits (ED), clinical visits. A Science Mag article on Telemedicine, Tipu Aziz, Professor of Neurosurgery at the University of Oxford stated “In the UK, telemedicine before COVID-19 was almost nonexistent. During the pandemic, in-person consultations dropped by 90% or more, with virtual visits at least partially filling the gap”. Synchronous telemedicine also refers to communication occurring between provider to provider. For example – ED doctors consult with remote stroke expert to create the treatment plan for the patient. Another example is Tele-ICU where the bedside team interacts with the offsite team for consultation in real-time. Telemedicine improved the safety of both patients and providers in times of Pandemic.
It refers to (store and forward) transmission of data from a patient or a physician to a specialist for diagnosis and treatment expertise. It refers to collection of digital samples that include electrocardiograms (EKGs), spirometry results, radiological images from one location and transferred to another location to a specialist for review. Asynchronous telehealth is effective in reducing wait time unlike synchronous telemedicine it’s free from real-time interactions between patients and physicians. Its low-cost infrastructure requirement makes it a preferred option, in an environment of high demand services, it can promote equitable access to physicians, specialists, and health professionals and services with limited health resources. Digital samples such as text messages, laboratory & radiology results can be transmitted to distant locations quickly and at a low cost. When these (asynchronous) services are integrated with centralized servers to manage digital samples, work lists can be divided and distributed among the team of specialist who can interpret it as per their availability, in scenarios where cases and worklist is prepared in advance, the specialist could report a higher turnover of their assessments without requiring face to face interaction.
Remote Patient Monitoring
Imagine your patient sipping coffee and reading a book in the kitchen of her home all the while her blood pressure, glucose, and other vitals are getting captured and reported to her doctor at his clinic. She doesn’t have to show up at the clinic, while her provider on the other hand is well-informed about her progress and equipped to manage her Diabetes. That’s Remote Patient Monitoring (RPM) at its finest for you. RPM is a method that utilizes Patient Data Management System that automatically retrieves the data from beside medical equipment such as patient monitor, ventilator, intravenous pump, patient’s wearable devices, and so forth. This data is summarized, structured, and shared with the providers to aid them in making an informed decision about their patients. RPM devices and technologies include continuous glucose monitor, wearables, Bluetooth devices that link via smartphone (for automatically uploading of patient’s data to a provider’s data storage platform). Studies evaluating community-based Remote Patient Monitoring has concluded that it effectively improves patient outcomes for chronic conditions such as heart failure, stroke, diabetes COPD, asthma, and hypertension. It plays an effective role in care continuation, post-discharge, and helps the provider in staying updated with patient conditions.
There is substantial evidence that Health Information Technology plays a key role in improving patient outcomes, patient safety, and saving time for the clinicians. CPOD, CDS have emerged as one of the most beneficial health information technology for improving patient safety, along with EHR. For critical care setting ADS systems and PDMS have demonstrated to be effective in improving patient safety outcomes. Telemedicine and Remote Patient Monitoring have been effective for the continuum of care. These technologies are effective in creating a Connected Care ecosystem.
Our EHR improves Care Coordination between the teams. Physicians, specialists, nurse, and other staff, all are provided access to the right information that improves the care coordination and enables the care team to provide Patient Care. Irrespective of whether a patient needs single provider or an extensive care team located in different places. Our EHR systems remove the barriers in decision making, communication, locations with telehealth integration it easily allows specialists to connect with the patients remotely and monitor their progress.
Our portfolio comprises of customizable and scalable EHR system integrated with telemedicine patient app, trad solution facilitating and connecting radiological experts for remote radiology interpretation, sync module – syncing and controlling all remote sites from one location for effective operations and management for a chain of hospitals, patient app – facilitating connected health, telemonitoring for critical care via Tele-ICU and ICURobot, Mobile Medical Clinics integrated with medical devices, eclinc platform supporting telemedicine and management of patient records. Health Bags – a portable clinic providing access to Primary health assessment, Diagnosis, Care Delivery, and monitoring. Health Kiosk – providing primary and preventive healthcare services, telemedicine platform for connected health care. HOPS Healthcare has been at the forefront in implementing HIT platforms. Our portfolio includes successful implementation of these platforms in developing countries with effective outcomes.