Optimizing Patient Safety Through IT Solutions: A Case Study

David Mosher presented to SickKids Patient Safety Symposium a personal case study titled "Optimizing Patient Safety through IT Solutions" based on his experience as the father of a child with complex care needs and a parent volunteer on SickKids family council and as a health care expert tasked with large scale mobile health care initiatives.

David describes his daughter as complex medically both in needs and in treatment concerns.

She also has an extremely wide circle of care extending to more than 10 sites at more than 5 different institutions.

As a father and IT professional, David then offers research and thoughts as to how technology adoption will improve the quality of information at the heart of patient safety.

Quality Information is Critical to Patient Safety

• “The majority of the key informants believed that the fundamental issue in patient safety and primary care is patient care information.”
(Kinston-Reichers et al., Cdn Patient Safety Institute)

• “During 32% of ER visits, missing information delays care”
(Stiell et al., 2004)

Increased Patient Safety Risk Factors

Can my wife and I get the answers right when under extreme stress?

What if we’re not there?

Very complex medical history/rare condition

My child cannot provide verbal feedback

Outbursts increase clinician stress, distracts and interrupts communication

Electronic Health Records are part of the solution

An E.H.R. provides a cross-provider, trusted healthcare record

But……….

• Is the info accessible at the point of care?
• Does it slow down the treatment process in E.R.?
• Is the information used to its potential?

Next Generation Mobile Devices Overcome the Access Barrier

- Light
- 10 hour battery life
- Intuitive user interface
- High resolution
- Built in cameras
- WiFi and 3G/4G
- Secure (no patient data on the device)
- Fast application deployment

Mobile Device Adoption is an unstoppable force in Healthcare

Clinical adoption of mobile devices is rising

• 72% of US Physicians use smartphones (Manhattan Research 2010)
• 52% look up patient information several times a day (Manhattan Research 2010)
• 50% of US physicians will have iPads by 2012 (Chilmark Research)
• 70% of Healthcare respondents plan to buy an iPad or similar device in the next year (HIMSS/BoxTone 2010 CompTIA 2010)
• 86% of Physicians with smartphones are interested in accessing EMR data by them (PwC 2010)

Conclusion

• The right information being available at the right time is crucial to patient safety

• E.H.R.s must be combined with mobile devices to have a meaningful impact

• IT can reduce the likelihood of errors that outside factors could introduce

David, thanks for sharing your presentation with us and for contributing to patient safety and family centered care at SickKids.

Where does the doctor place the computer?

Pauline Chen's "An Unforeseen Complication of Electronic Medical Records"
is a timely focus on the computer's not yet comfortable place in the patient-doctor relationship.

...that afternoon as I settled in to see my first clinic patient, I realized I had no idea where to sit. The new computer was perched atop a desk in one corner of the room; the patient sat on the exam table on the other side of the room. In order to use the computer, I had to turn my back to the patient as I spoke to him. I tried to compensate by sitting on a rolling stool but soon found myself spending more time spinning and wheeling back and forth between patient and computer than I did sitting still and listening. And when my patient did talk, his story came only in spurts because every time I turned my back to him to type, the room fell silent.

My vision of an interaction marked by the seamless flow of conversation and capture of information vanished. Instead, I was spinning my wheels. Literally.

Yes, it gets better. Read the full article here.

Chen's article is based on the release of "Electronic Medical Records and Communication with Patients and Other Clinicians: Are We Talking Less?", a study based on how EMR's effect clinician's interpersonal communication in 26 practises. The study is a very worthwhile read, here is a summary graphic that you can click on to enlarge.

Sickids Patient Survey Now Online

Sickkids.ca recently added an online Quality and Risk Management survey to their homepage titled "How Are We Doing?". The survey begins with a personal letter from Sickkids President Mary Jo Haddad explaining the importance of your information, that it will be carefully reviewed to improve care, held in confidence and to answer any questions please contact the Patient Representative.

You rate 11 aspects of care such as Admission, Nursing Care, Medical Care, Family Centred Care, Information etc as either Excellent, Very Good, Good, Fair, Poor or No Contact. You provide discharge date, child age, clinics or units visited, offer open comment on What Impressed You, What Disappointed You, How Can We Improve patient safety, Other Suggestions and finally optionally provide name and contact information (phone number is asked but not email address).

My immediate thought was yeah, I hope this remains a permanent website fixture. Probably to keep the number of questions down, elements are lumped together so with Medical Care for example you are asked to consider "Caring and concern shown by doctors, attention to your child’s (or your) condition, how easy it was to see doctors, teamwork among doctors" when individual doctors can vary on any one element. The four commment fields have the potential to generate rich data. I see it is not secured by SSL certificate but since you can send personal information it probably should be.

Good to see Sickkids!

Ability Online: free, monitored, online child and parent support community

In October I had several conversations with Michelle McClure, director of AbilityOnline.org and am excited to hear they are retooling their online community. Here are blurbs from their website:

Ability Online is a free and monitored online support community that links kids with disabilities or illness to other kids and adults who care. In a password-protected environment, we offer monitored topical discussion threads, email and chat facilities, and games and activities where kids can come together and just be kids. Then, when they are ready, health information, peer support, and opportunities for skill development are just a mouse click away. Ability Online also offers private e-communities to off-line support groups which can benefit from the extended access of an online facility. This is particularly helpful for organizations whose outpatients are restricted by geographical barriers.

Ability Online is an extraordinary and absolutely free Internet community. Here, young people with disabilities and illnesses connect with all kinds of possibilities that address their needs as curious, growing citizens of the planet. They meet and chat with other people like them in a virtual world that transcends boundaries and barriers. They make friends, get tips from mentors, and freely participate in an atmosphere of collaboration, companionship and support. And this remarkable community also provides many benefits to parents, family members and others who want to make a difference in enabling and enriching the lives of those they know and love. What Ability Online is not is a highly trafficked, public online area, where anyone can come and go and chat and boast and bully… and engage in all those dubious behaviors the Internet is accused of breeding. Ability Online is available 24 hours a day and is monitored by caring, responsible volunteers who share in the dream of a place where worries are set aside, heartaches are healed, and good things happen to those with hardship in their lives.

The over nine year old website technology will be overhauled in December and the bulletin board and chat tools greatly expanded and streamlined with the help of a substantial programming contribution by Momentum Advanced Solutions Inc. I suggested adding the ability to tag or label content so that users can search for specific threads, such as for particular hospitals, deceases etc and that users have a profile area where they can share more about themselves if they wish to. Similarly over the next month or so they plan to setup a Family Advisory that Michelle invited input to. I see a natural connection between parents and children connecting via the web and family presence and advisory initiatives and knowledge exchange in hospitals. For further information and to contribute to Ability Online networking or fundraising, please contact: Michelle McClure, Director of Program Development and Member Services, Ability Online, Tel.
416-650-6207, email: michelleATabilityonline.org

Workshop on SickKids family-team communication

The Sasha Bella Fund will participate in a communication workshop on March 17 for Sick Kids staff planned by Pam Hubley (Associate Chief of Nursing Practice), Lorelei Lingard (Scientist, Sick Kids Learning Institute) and Karen LeGrow (CCCU, Research Institute, Faculty of Nursing University of Toronto). The focus of the workshop is to engage in dialogue and critically reflect upon the way in which SickKids staff communicate with families and each other (team members).

Empowering Family in 'Family Centred Care'

Here are several broad initiatives to deliver family centred care in a large complex medical institution like SickKids Hospital.

1. Expand parent participation to every service and most teams in the hospital aiming to reflect the race, gender and background of the parent population as a whole. The hundreds of volunteer hours per month are provided by parents whose children are no longer in care, are experiencing a positive care path or volunteers interested in contributing their experience. The 2005-2006 Family Advisory Committee report notes it was "initiating a transition that will soon see the Hospital assume full administrative responsibility for the program. This should enable many more staff and students, often in interdisciplinary groups, to participate in the sessions and to take away with them ideas to draw upon and strategies to apply in their practice." The hospital could then go further, introducing parent advisory involvement at all levels.

2. Expand patient and family participation in SickKids data flow to open electronic access to the key data (contact info, diagnosistic history, care maps, schedules, actionable items, parental presence and resusitation wishes) and provide an entry point for notes on meds, symptoms and daily events. The parent login facilitates family-centred interprofessional practise and makes transparent all possible junctures along the care path including DNR orders. No such parent editable access exists however computer databases are being devised and funded continually and SikKids website is to be completely revamped.

3. Thanks to a blog comment on this entry, demonstrating the power and speed of collaborative data, we can naturally add a third facilitator of family-centred care: helping families to connect at parent meetings with a SickKids facilitator (as on floors 5 and now 4) or as Lisa suggests via a buddy system. So simple you can see the signs: Get a Buddy; Become a Buddy.

We would love to hear of any successful initiatives relating to family advisory committees, collaborative computing or parents helping parents that you might have seen, heard or read about at SickKids or elsewhere.