The need for integrated patient care to help reduce medical errors, a $20B plague for U.S.
The U.S. health care system, among the best in the world with highly skilled clinicians trained at the world’s leading medical schools, suffers a fatal flaw: medical errors, which are responsible for roughly 1 in 10 American deaths and cost the country $20 billion a year. Nearly 2 out of 3 of these errors are rooted in poor communication among the care team.
Poor communication ranges from a misheard word in a noisy emergency department to a mistaken patient identity. Breakdowns are most likely to occur in patient handoffs across departments, from primary to secondary care, at the change of shifts, and across professional boundaries. Hierarchies, high acuity settings (e.g., operating rooms), and multiple treatment sites also complicate care.
Amid proliferating telehealth and other arms-length encounters during the COVID-19 pandemic, an error is likely to be administrative in nature, linked to communication gaps within the electronic health record (EHR) and other provider systems.
Often the glitch is the inability of the system(s) to integrate data from all care teams who see patients – including primary and secondary care, emergency and outpatient care, and teams treating disparate comorbidities – as well as all of the ancillary applications involved in health care delivery.
Presentation of that data is another issue. Even though clinicians’ notes, prescriptions, diagnostic results, visits, vitals, histories, insurance, and other records pertaining to a patient are online, that hardly means they’re easily accessible to every busy clinician who sees the patient. Clinicians must either dig for information, often switching among multiple devices and applications, or proceed with an incomplete picture.
Burnout from bad tech can lead to medical errors
Worse, many clinicians are arriving at these encounters burned out on bad technology. Even prior to the pandemic, burnout had reached crisis levels with as many as 54% of nurses and physicians and 60% of medical students and residents reporting symptoms, according to the U.S. Surgeon General.
A myriad of factors contribute to burnout, including “burdensome administrative paperwork” and “lack of human-centered technology,” according to the report. “For every hour of direct patient care, physicians currently spend two hours on the Electronic Health Record (EHR) system,” the report says. “Nurses spend up to 41% of their time on EHRs and documentation.”
Lacking the time and appetite for getting mired in a tangle of applications, clinicians often treat the patient based on what they know at the time of the visit and what the patient tells them (or doesn’t).
Although death is the worst-case scenario, errors and miscommunication often result in “mere” suboptimal care and flagrant waste. These problems plague all areas of health care delivery, including diagnosis, treatment, scheduling, referrals, and billing. Unfortunately, even the most comprehensive treatment plan is likely to fail without connecting and coordinating all health care providers involved.
How EHRs Can Reduce Costly Mistakes
EHRs are essential tools that have the ability to help reduce medical errors and the expense they bring. This is especially true when the EHR delivers a personalized experience that integrates information from all relevant systems in the health care delivery chain. Here are seven elements of an EHR that can significantly reduce the instances of poor communication between medical providers that ultimately lead to costly mistakes:
Mobile device integration. According to a HIMSS Analytics study, 80% of C-suite executives, IT pros, clinicians, and health care department heads already use tablets, and 43% use smartphones to provide and coordinate care. Including an integrated EHR on every communication platform a health care provider is likely to use — including smartphones, tablets, laptops, desktops, email, IM, patient portals, internal videoconferencing, and telehealth — ensures that the more accurate and up to date information is always at hand and in turn ensures a more accurate treatment plan.
Complete patient support. Clinicians and support staff from every care team, including behavioral and physical health, should be able to view a succinct synopsis of the patient’s condition and treatment plan that they can digest in 60 seconds before the appointment. This synopsis should include all relevant diagnoses, medications, lab results, providers, appointments, population categories, and social determinants of health.
Filtering capabilities. Less information can be more, so each user’s view would be efficiently configured to their role and needs with intuitive links to more information, further helping to get to the critical information quickly.
A familiar interface. Social platforms brilliantly integrate information from a myriad of sources and present just what you’re looking for before you start looking. In the health care setting, a socially informed EHR should include notifications when important variables change like a new prescription, diagnosis, provider, appointment, or life event.
Voice recognition. To reduce burnout and marshal information effectively, EHRs that respond to voice commands and seamlessly convert voice to text increase efficiency and enable health care providers to more quickly get back to treating patients. This capability should ensure that clinicians can speak rather than type information into systems that manage appointments, orders, lab reports, treatment plan updates, prescriptions, visit verifications, and more.
Continuous learning. An integrated EHR with artificial intelligence capabilities can anticipate what you’re about to say in your notes or structured data fields, continuously learning how the provider works. It can offer increasingly accurate predictive text whether using a keyboard or voice dictation to update patient information. And it can scour clinician notes and come up with accurate billing codes, further saving the provider money.
Secure patient access. Patients hate red tape as much as clinicians do. So their experience with their provider(s) should be just as integrated and coordinated as the clinician’s. It should be easy to invite patients into a tailored section of the shared EHR environment (with appropriate security), providing them with streamlined access to their clinicians as well as scheduling, health records, prescription refills, lab results, notes, scheduling, and educational materials. Even basic patient engagement can be cost-effective for example, reducing the need for administrative assistants to phone patients with appointment reminders.
EHRs that work like this could help reduce medical errors and unnecessary expenses by enhancing communication in an easy to use way. By leveraging data from all sources, including clinicians’ spoken words, and systematically integrating it around every patient for each health care worker’s role, we can intelligently present information to each clinician and staffer involved in any aspect of health care delivery – including clinicians from different disciplines treating the same patient for different conditions.
Errors will happen, but many of them are avoidable. We know where problems lie and how to fix them. Let’s do it.
Khalid Al-Maskari is founder and CEO of Health Information Management Systems (HiMS), a Tucson, Ariz.-based company that designs Electronic Health Records (EHR) software to transform the integrated health care experience. HiMS creates innovative solutions that lead to better outcomes, lower costs and higher-quality care.