Framework

Health information technology (HIT) can play a major role in improving outcomes for patients and the financial performance of healthcare providers. Investment in HIT has become more compelling due to technical advancements that improve functionality and ease of use, as well as pressure and incentives from consumers, government and regulators.

HIT provides enhanced patient monitoring, improved caregiver communication and increased access to clinical decision support data.  As a result, clinical systems offer the promise of reduced medical errors, decreased variation in care, and better outcomes.  However, there are barriers to the implementation and acceptance of HIT systems. These include capital investment, clinician adoption and inadequate standards to allow the seamless integration of different systems.

Major Initiatives

There are three major HIT initiatives currently receiving attention:

Electronic Medical Records (EMR), sometimes called electronic health records. EMRs digitally store patient information, which allows easy access to critical information by caregivers at the point of care. By facilitating access to patient information, EMRs can improve quality, decrease the number of medical errors and limit unnecessary testing and treatments. Additional efficiencies may come from administrative costs due to the increased efficiency of managing medical records (e.g., storage, retrieval).

Computerized Physician Order Entry (CPOE). CPOE enables providers to create patient orders electronically, which are then routed to the appropriate department for completion (e.g., pharmacy, laboratory). When combined with a clinical decision support system that accesses clinical databases, it can reduce variability through a decrease in sub-optimal decisions. For example, CPOE allows easy access to patient-specific, proven order sets; automatic drug-checking and clinical guidelines. In addition, CPOE can reduce mistakes associated with handwritten or verbal instructions.  To achieve its potential, CPOE should be implemented with a deep review of clinical processes.

Bar Coding. Properly implemented bar coding technology can greatly improve the accuracy of medication management. In addition to reducing errors during the dispensing process, it helps ensure the five rights of medication administration: right drug, dose, route, time and patient. Handheld scanners are used to check the drug and patient with the medication order as both are uniquely bar-coded. Although this technology does not ensure appropriate medication orders, it helps guarantee that orders are accurately executed.

Key Questions

Key questions that hospital leaders should be discussing within their organizations include the following:

1.  What role does HIT currently play in the quality of care our hospital provides?

2.  In what ways can we expand the use of HIT to further improve quality?

3.  How do we evaluate the options to expand HIT with regard to cost/benefit of improving quality and patient safety at our hospital?

4.  What can be the unintended consequences of HIT implementation and how may it compromise quality and patient safety?