With all the discussion surrounding the ARRA and HITECH legislation one cannot help but wonder – what about all those on the “early adoption curve” for their EMR?  When systems were installed in the late 90’s and To Err is Human had not yet been published – it was impossible to build for standards that had not yet been developed or even identified?  In the intervening years as the pressure has built to further develop our information system environments the competing priorities have been overwhelming at times.  The regulatory environment has imposed the “un-funded” mandates and the easy patch for these needs have been manual chart review and abstraction to answer the call for information.

In early 2009, I worked with a client on an engagement that allowed for a review of some of these challenges.  There was one hospital with a well established CIS installed with default design decisions that force patient safety measures to be abstracted from the manual chart.  An example was noted in the Emergency Dept where the time frame from patient arrival to antibiotic administration in instances of community acquired pneumonia is measured.  The default time documented as the ED nurse charts is the time the medication was ordered – not the time administered or even the time charted.  This means for reporting this important JCAHO Core Measure/CMS quality measure is reviewed by hand!   There was not the opportunity to explore how many instances of this type of decision exist but it seems obvious that the potential is there to uncover more?

The opportunities presented by ARRA and HITECH require organizations to optimize their installed systems for meeting the new meaningful use measurements.   One would hope there will be comparisons of patient safety and quality standards with meaningful use standards and develop methods to meet both.  This is work that can lead to decreased time by the quality staff and also help the organization to meet meaningful use standards.  This is work that can be done to both assist in accomplishing both meaningful use and quality and patient safety standards by optimizing the current environments of the far sighted early installers of EMR applications and systems.  Santa Rosa Consulting is helping our clients do just as I suggest.  Please contact us for more information.

Karen Hollingsworth, RN, MS, CPHIMS
Associate Partner
Santa Rosa Consulting

Photo Credit: Redwood Area Hospital Copyright © 2009 http://www.redwoodareahospital.org/patient%20safety/mha.htm