Commentary: They Must Embrace the Vision
UHN's MOE/MAR implementation was leveraged by embracing it as the "right thing to do" rather than just jockeying for a competitive advantage in the marketplace. Even with the obvious overall benefit, however, UHN was scrupulous with its business decision:
Before the project received the green light, however, there was considerable debate among members of the executive team. The point of contention: Was the MOE/MAR project truly the best use of time and money in comparison to other much-needed and much-requested initiatives? Other initiatives that were considered included clinical documentation, clinical decision support alerting for lab and diagnostic orders and incident reporting electronic system changes.
Ultimately, it was decided that attempting to manage multiple patient safety projects would be too much of a drain on financial and people resources. As well, implementing multiple initiatives simultaneously would likely be too much change for the organization to handle. Based on the expected relative impact on patient safety, compared with these other initiatives, the choice was made to support MOE/MAR. (Excerpt from "Executive Perspective: The Business Case for Patient Safety," by Anderson et al., at p. 20 in this issue of Healthcare Quarterly.)
UHN's business decision can be supported by organizations recognized for their excellence in implementation and use of electronic health record systems, such as those receiving the HIMSS Nicholas E. Davies Award of Excellence. Two past Davies award recipients cite a number of patient safety improvements in several areas in addition to improving prescription practices:
Maimonides Medical Center (Davies 2002,
davies_2002_maimonides.pdf ), a 705-bed hospital, saw problem medication orders drop by 58% and medication discrepancies by 55% in 2001 after its EMR-EHR implementation. That same year, the decision support feature identified 164,250 alerts, resulting in 82,125 prescription changes. The provider's EMR-EHR addressed "high alert medications," confusing look-alike and sound-alike drug names, as well as patients with similar names that could potentially cause the pharmacy confusion.
On-line medication charting saw errors in transcription drop to
zero for departments in which EMR-EHRs were in full use at Ohio
State University Health System (Davies 2001,
davies_2001_osuhs.pdf ). In areas where the EMR-EHR had not been implemented, transcription errors ran as high as 26% in its system. Other healthcare providers also saw transcription errors drop to zero.
Although healthcare is ultimately a business, the patient must stay anchored at the core. UHN's decision to improve patient care through its MOE/MAR implementation is an example of industry leadership for others to embrace.
About the Author
David A. Collins, MHA, CPHQ, CMOM, is Manager of the Davies Awards Program at the Healthcare Information Management and Systems Society (HIMSS) in Chicago, IL.
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