Healthcare IT can increase patient safety, but adoption remains suboptimal, according to Ramin Khorasani, MD, MPH, section head for enterprise information systems for Society for Imaging Informatics in Medicine (SIIM) who spoke yesterday to a packed audience in Austin, Texas on enterprise information systems.
Medical errors are pervasive throughout medicine including radiology and have been documented by the Institute of Medicine. “Radiology errors occur in test utilization, patient care, image interpretation and result communication,” explained Curtis P. Langlotz, MD, PhD, associate professor of radiology at University of Pennsylvania. Langlotz identified four elements of the computerized environment that can reduce medical errors: electronic health records, computer-aided decision support, electronic order entry and interoperable electronic information exchange.
“The integrated electronic work environment with full access to the patient record, advanced image processing and display and structured reporting tools can reduce errors by reducing or eliminating mismatches between images and reports, optimizing utilization via electronic order entry, triggering decision support and speeding and standardizing communication and reporting,” summed Langlotz.
Change management in IT
Maria Damiano, director of PACS operations at Brigham and Women’s Hospital, outlined the steps for effective change management based on the Brigham’s enterprise PACS deployment.
- Establish a sense of urgency.
- Form a powerful guiding coalition.
- Create a vision.
- Communicate the vision.
- Empower others to act upon the vision.
- Plan for and create short-term wins.
Damiano offered other tips to boost PACS buy-in. They include soliciting feedback about positive, negative and desired features and correlating user needs and system features as users are introduced to the new system.
Enhanced safety, quality and efficiency
Enterprise information systems can improve safety, quality and efficiency as medical imaging utilization escalates, Khorasani noted.
Radiology errors can stem from misuse, overuse and underuse of imaging tests. IT adoption can correct incomplete or inaccurate paper requisitions, reduce RIS data entry errors, standardize heterogeneous order entry and limit inappropriate use of radiology resources, Khorasani said.
He measured a $10 waste per CPT performed at Brigham and proposed using $5 per CPT to fund IT adoption such as computerized physician order entry, building in workflow incentives to boost buy-in and adoption.
Brigham developed the Electronic Round Trip to fulfill its vision of the filmless, paperless, errorless enterprise. Components include decision support and CPOE. Khorasani concluded with benefits to date: reduced film use and costs outside of radiology and an 80 to 90 percent adoption of order entry among referring physicians.