Patient Safety and Health IT: What's on the Horizon for Clinical Labs
Since the release of the 1999 Institute of Medicine Report on medical errors, U.S. federal policymakers have worked hard to improve patient safety. In 2005, Congress passed patient safety legislation encouraging the reporting and analysis of medical errors and the dissemination of related findings. On the regulatory side, government agencies are working to refine and implement quality indicators for labs and to create an electronic health record (EHR) by 2014.
These were a few of the topics of discussion during last month’s Patient Safety and Health IT audioconference, hosted by AACC, ACLA and ASCLS. During the 90-minute presentation, a panel of experts commented on the status of these initiatives and what they will mean for labs. Here’s a brief summary of the conference:
New Patient Safety and Quality Improvement Act of 2005
Peter Kazon, JD, Senior Counsel for Alston & Bird, discussed the importance of the new Patient Safety and Quality Improvement Act of 2005, which seeks to improve patient safety and reduce incidence of safety-related events.
Administered by the Agency for Healthcare Research and Quality (AHRQ), this Act established Patient Safety Organizations (PSOs) and patient safety databases that will analyze national and regional statistics, including trends and patterns of healthcare errors. Information resulting from these analyses will be made available to the public and included in the annual quality reports prepared by AHRQ.
The Act also enables healthcare providers — including clinical laboratories — to voluntarily contract with Patient Safety Organizations (PSOs) in their efforts to:
- Collect and analyze data on patient safety events, including “near misses,” “close calls” and “no-harm” events, as well as all types of adverse healthcare events
- Provide feedback and assistance to effectively minimize patient risk
- Develop and disseminate information to improve patient safety
- Change healthcare structures and processes to improve health outcomes without fear that data will be used in legal or administrative proceedings against the
Kazon concluded his discussion by encouraging healthcare providers to contract with one or more PSOs and noted that JCAHO has announced its intent to become part of a PSO under the auspices of its new International Center for Patient Safety.
The Use of Performance Measures to Improve Quality
Next, Joe Boone, PhD, Associate Director for Science in the CDC’s Division of Public Health Partnerships, discussed the use of performance measures to improve quality.
He noted that labs, specifically, should aim to improve two types of service measures. One — the coordination of care measures — involves interactions between labs and their customers. The second — laboratory service measures — includes the major factors impacting labs’ ability to provide quality care (e.g., TAT, test order accuracy).
To achieve success, labs must continue creating performance measures that:
- Are evidence-based and practice-tested
- Address identifiable healthcare quality problems
- Are based on objective, consistent and easily collected metrics
- Allow external and internal evaluation over time
- Address a wide range of lab tests and sites
- Focus on test utilization: over-use, under-use and mis-use of testing services
- Provide incentives for collection and auditing of measures
How Labs Are Adapting to the New Health IT Environment
Lastly, Jay Jones, PhD, Director of Regional Labs and Chemistry at Geisinger Medical Center (Danville, PA) and Chair of AACC’s Lab Information and Medical Informatics Division, shared his labs’ firsthand experience adapting to the new health IT environment.
Dr. Jones stated that lab safety and quality remain among the top focuses for this regional network and, to stand up to these new challenges, it relies on:
- A wide area network (WAN)
- A departmental LIS with air-tracking
- Inter-departmental decision-support subsystems
- Lab processes that support performance-verified best practices
- Enterprise-wide electronic health records (EHR)
“I believe the electronic health record is really where it will be in the future because it’s not only the provider interface, it’s also being increasingly used as the patient interface,” said Dr. Jones. “We really want to focus our best practices, quality performance and outcome analyses based on the electronic health record and what it can bring to us. Then we really need to aggregate this information to supply the best possible information to customers.”
The hospital also uses many processes to track lab errors that could affect patient safety and quality. For example, the lab: - Uses 53 credit comments in the LIS to identify/specify individual lab errors
- Collects, tabulates, reports and tracks all error comments every month
- Identifies all pre-analytical errors, such as patient mis-identification, hemolyzed specimens, improper collection and use of wrong containers
- Categorizes all analytical errors, including any manual errors, sample mis-entries and instrument malfunctions
- Itemizes all post-analytical errors, such as test results delivered to the wrong provider or location, and any delays in reporting critical values
- Collaborates with other departments (e.g., pharmacy) to identify combinations of factors that may indicate an unsafe condition (e.g., diazide administration, elevated digoxin)
- Uses processes that force the issue of patient quality (e.g., requiring the proper scan of patient wristbands)
- Utilizes data mining techniques to validate archived information
“Since all errors are already in our computer, we can track them very easily — and measure them against our total number of billed tests,” said Dr. Jones. “This method provides a good reality check as the complexity of our regional outreach business increases.”
“Health Information Technology will continue to fundamentally change the way we practice laboratory medicine,” concluded Dr. Jones. “It enables us to provide our product — information — to our customers (patients, providers and payors) with documented quality and safety. I think we’re at the beginning of a movement that is going to pull us far into the future.”
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