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CMIOs Say Medication Management Is Improving, But Still Needs Work

Posted on September 14, 2018 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new survey suggests that chief medical information officers are optimistic about the progress they’ve seen in medication management processes though they still see some obstacles that need to be tackled. Their top concerns seem to be related to the sharing of prescription information and a lack of faith in the medication lists as they’re currently generated.

According to research conducted by the Association of Medical Directors of Information Systems (AMDIS) and vendor DrFirst, medication management improvement efforts have made a positive impact on the rate of adverse drug events over the past five years.

About half of the CMIOs said they were satisfied with their existing medication management process, while 12% said they were dissatisfied.

The CMIOs reported that the biggest gaps in the medication management process were incomplete patient medication histories (cited by 80%) and misaligned medication reconciliation and care transition cycles (75%). Respondents said that this kind of misalignment sometimes lead to misinformed decisions by care teams.

Another vulnerability respondents identified was lack of visibility into patients’ medication adherence levels, with 91% calling it the biggest gap in medication history adherence and monitoring. They didn’t name any particular solution that could address the problem, though existing medication management apps for consumers might at some point address this issue.

Eight-five percent of responding CMIOs said that when patients don’t participate in the medication reconciliation process it leads to gaps in the patient medication history. They didn’t specify the point in the process at which it might be most helpful to involve patients.

In addition, 95% of respondents said that it would help matters to cut down on the order entry and data validation tasks pharmacists and clinical staffers had to perform, arguing that it would enhance patient safety and improve efficiency.

Other patient safety concerns they cited included a lack of process buy-in and/or process compliance (77%), a lack of process ownership (73%) and workflow variations across departments (91%).

As part of the discussion, the surveyed CMIOs noted that the right technology approach could help them address the opioid epidemic.

As things stand, they told AMDIS, it’s not clear the providers are able to prevent opioid abuse since at times they can’t easily distinguish between drug “shoppers” and other patients.

However, 65% of CMIOs said that if providers could access an integrated clinician workflow including e-prescribing of controlled substances, access to state Prescription Drug Monitoring Programs to track patients’ opioid histories and access lists of other prescriptions, it would be easier for them to avoid potentially harmful drug combinations.

Patient Safety Market Heating Up with Mergers and New Product Announcements

Posted on July 26, 2018 I Written By

Colin Hung is the co-founder of the #hcldr (healthcare leadership) tweetchat one of the most popular and active healthcare social media communities on Twitter. Colin speaks, tweets and blogs regularly about healthcare, technology, marketing and leadership. He is currently an independent marketing consultant working with leading healthIT companies. Colin is a member of #TheWalkingGallery. His Twitter handle is: @Colin_Hung.

For the past few years the patient safety software market has been stable with little in the way of new products and company activity. That has changed with a flurry of recent announcements:

  1. The merger of two market leaders: Datix and RL Solutions
  2. Health Catalyst entering with their new Patient Safety Monitor™ Suite: Surveillance Module
  3. VigiLanz expanding their platform to include Dynamic Safety Surveillance

When something goes wrong in a healthcare facility it is referred to as an adverse event or a medical error. According to a recent study by Johns Hopkins, 250,000 Americans die each year from medical errors making it the third leading cause of death in the United States. The Journal of Patient Safety estimates that non-lethal adverse events happen 10-20 times more frequently than lethal events. This puts the total number of adverse events somewhere between 2.5 – 5 million per year. The financial cost of these events is enormous. Frost & Sullivan estimates that the financial cost of adverse events in the US and Europe will reach $383.7 Billion by 2022.

Traditionally, adverse events have been recorded and logged in incident reporting systems (sometimes called risk management software) – like those offered by Datix and RL Solutions. These systems rely on voluntary reporting of events by staff members and patients. Once entered, these events are reviewed and analyzed by specially trained risk managers to determine root causes. When patterns emerge, changes are made to policies, procedures and physical environments to prevent similar events from happening in the future.

The most recent Research and Markets report estimates the global patient safety and risk management software market is poised to grow at a CAGR of 10.9% over the next decade to reach $2.22 Billion by the year 2025. I believe there are three key drivers for this this growth:

  1. Hospitals transitioning away from traditional after-the-fact adverse event reporting systems to real-time surveillance platforms that take advantage of the data being collected in EHRs and other electronic repositories
  2. The movement towards value-based care where a focus on patient safety has meaningful impact on reimbursements
  3. Realignment of patient safety as part of overall patient experience vs a function of compliance and legal.

According to a report by the Agency for Healthcare Research and Quality (AHRQ), it is estimated that less than 6% of adverse events are reported voluntarily. This means that healthcare organizations are potentially missing out on 94% of events that are happening within their four walls. In addition, very few organizations have effective ways to capture near misses – adverse events that did not occur because they were stopped BEFORE someone was harmed. There is a better way.

With the exponential growth in the quantity of healthcare data and the rapid increase in computing power, it is now possible to mine medical data to detect adverse events and near misses in real-time. For example, it is possible to look at EHR data to determine if the wrong medication was given to a patient based on their diagnosis. It is also possible to track the number of times the drug-drug interaction warning message is displayed to clinicians (each being a near miss). Justin Campbell of Galen Healthcare Solutions recently wrote an article about mining EHR audit log data to uncover workflow bottlenecks that touches on this same approach – commonly referred to as “real-time surveillance”.

Stanley Pestotnik, MS, RPh, Vice President of Patient Safety Products at Health Catalyst had this to say about this detection methodology: “The current approach to patient safety is like doing archaeology – digging through ancient safety events to identify the causes of harm, which does nothing to help with the patient in the bed right now. Our patient safety suite, along with our quality-improvement services and the Health Catalyst PSO, turns the current paradigm on its head. Unlike other approaches to using analytics within a PSO to identify and address episodes of patient harm, we monitor triggers in near real-time to reveal whether a patient is currently at risk for a safety event, so clinicians can intervene to prevent it. And we provide constant vigilance; no patient encounter goes unnoticed.”

Real-time surveillance of adverse events is the approach that Health Catalyst and VigiLanz have incorporated in their product offerings.

“The RL+Datix merger comes at a time when patient safety events are surging,” states Erik Johnson, Vice President of Marketing at VigiLanz. “It is not surprising that consolidation is happening as companies try to address the needs of the market.”

Johnson points to a recent Frost & Sullivan report that predicts further market consolidation. The report states that by 2022, adverse patient events will lead to 92 million hospital admissions and 1.95 million deaths in the US and western Europe. These avoidable hospital admissions will be a drag on financial performance – especially as we move to a value-based system.

Under the value-based models, healthcare organizations are reimbursed based on patient outcomes and satisfaction scores, not on treatment volume. This means organizations are no longer compensated for patients that are re-admitted or stay longer due to an adverse event experienced at the facility. This has put a spotlight on patient safety initiatives and is a key reason why healthcare organizations are once again investing in this aspect of their operations.

“We are seeing organizations take the opportunity, as they transition from volume to value, to renew their patient safety protocols and technologies to ensure they are capitalizing on the lessons learned from incident data,” continues Johnson. “It’s not just patient incident data either. Adverse events can happen to guests and employees as well. Hospitals are looking to get a better handle on all their events – not only to capture them, but to derive deeper insights on root cause and even further to automate the detection of events through surveillance technology.”

A request for comment from Datix and RL Solutions on their recent merger was politely declined. A company spokesperson pointed back to the press release announcing the merger which states: “the combined company will contain the largest repository of patient safety data in the world, enabling the creation of data-driven insights for healthcare stakeholders across the continuum of care.”

The final driver for growth is the recognition that patient safety is closely linked to patient experience. In the past, adverse event tracking fell to the Risk Management team inside a hospital which typically reported up through the CFO or legal counsel. It was seen as a compliance and back-office function. In recent years, however, there has been a realization that the patient safety function is a better fit under the umbrella of patient experience since the two are closely linked.

“From our perspective at The Beryl Institute, if we approach healthcare from the lenses of those that use the system not only safety, but also quality, service, cost and more are all part of the experience someone has within healthcare,” says Jason A. Wolf PhD CPXP, President of The Beryl Institute – the world’s leading community of practice for patient experience. “To differentiate safety from experience diminishes both, relegating safety to processes and checklists and experience to satisfaction or amenities. Rather, experience is the integration of all the above.”

Wolf cites the recent State of Patient Experience from The Beryl Institute where healthcare leaders acknowledged quality and safety as essential to overall experience. A parallel study, the Consumer Perspectives on Patient Experience mirrored the provider result with 68% of global healthcare consumers agreeing that safety is part of the healthcare experience.

“I see the movement towards aligning patient safety and patient experience as acknowledgement of all that impacts the overall experience,” adds Wolf. “That first and foremost to consumers, their health matters to them and how they are treated both clinically and as a person is essential to their healthcare experience. This too reinforces the expectations patients and families have always had, that their care will be delivered in a safe and reliable manner.”

lt will be exciting to watch the patient safety space as the three drivers of (1) changing technology, (2) value-based care and (3) realignment under patient experience, continue to push investments in this market. I’m curious to see if the Datix + RL merger is a one-off or if other players like QuantrosRiskonnect, Origami Risk, Ventiv, Policy Medical and The Patient Safety Company will merge or be acquired. This market is definitely heating up!

Managing Health Information to Ensure Patient Safety

Posted on August 17, 2016 I Written By

Erin Head is the Director of Health Information Management (HIM) and Quality for an acute care hospital in Titusville, FL. She is a renowned speaker on a variety of healthcare and social media topics and currently serves as CCHIIM Commissioner for AHIMA. She is heavily involved in many HIM and HIT initiatives such as information governance, health data analytics, and ICD-10 advocacy. She is active on social media on Twitter @ErinHead_HIM and LinkedIn. Subscribe to Erin's latest HIM Scene posts here.

This post is part of the HIM Series of blog posts. If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

Electronic Medical Records (EMRs) have been a great addition to healthcare organizations and I know many would agree that some tasks have been significantly improved from paper to electronic. Others may still be cautious with EMRs due to the potential patient safety concerns that EMRs bring to light.

The Joint Commission expects healthcare organizations to engage in the latest health information technologies but we must do so safely and appropriately. In 2008, The Joint Commission released Sentinel Event Alert Issue 42 which advised organizations to be mindful of the patient safety risks that can result from “converging technologies”.

The electronic technologies we use to gather patient data could pose potential threats and adverse events. Some of these threats include the use of computerized physician order entry (CPOE), information security, incorrect documentation, and clinical decision support (CDS).  Sentinel Event Alert Issue 54 in 2015 again addressed the safety risks of EMRs and the expectation that healthcare organizations will safely implement health information technology.

Having incorrect data in the EMR poses serious patient safety risks that are preventable which is why The Joint Commission has put this emphasis on safely using the technology. We will not be able to blame patient safety errors on the EMR when questioned by surveyors, especially when they could have been prevented.

Ensuring medical record integrity has always been the objective of HIM departments. HIM professionals’ role in preventing errors and adverse events has been apparent from the start of EMR implementations. HIM professionals should monitor and develop methods to prevent issues in the following areas, to name a few:

Copy and paste

Ensure policies are in place to address copy and paste. Records can contain repeated documentation from day to day which could have been documented in error or is no longer current. Preventing and governing the use of copy and paste will prevent many adverse issues with conflicting or erroneous documentation.

Dictation/Transcription errors

Dictation software tools are becoming more intelligent and many organizations are utilizing front end speech recognition to complete EMR documentation. With traditional transcription, we have seen anomalies remaining in the record due to poor dictation quality and uncorrected errors. With front end speech recognition, providers are expected to review and correct their own dictations which presents similar issues if incorrect documentation is left in the record.

Information Security

The data that is captured in the EMR must be kept secure and available when needed. We must ensure the data remains functional and accessible to the correct users and not accessible by those without the need to know. Cybersecurity breaches are a serious threat to electronic data including those within the EMR and surrounding applications.

Downtime

Organizations must be ready to function if there is a planned or unexpected downtime of systems. Proper planning includes maintaining a master list of forms and order-sets that will be called upon in the case of a downtime to ensure documentation is captured appropriately. Historical information should be maintained in a format that will allow access during a downtime making sure users are able to provide uninterrupted care for patients.

Ongoing EMR maintenance

As we continue to enhance and optimize EMRs, we must take into consideration all of the potential downstream effects of each change and how these changes will affect the integrity of the record. HIM professionals need prior notification of upcoming changes and adequate time to test the new functionality. No changes should be made to an EMR without all of the key stakeholders reviewing and approving the changes downstream implications. The Joint Commission claims, “as health IT adoption becomes more widespread, the potential for health IT-related patient harm may increase.”

If you’d like to receive future HIM posts by Erin in your inbox, you can subscribe to future HIM Scene posts here.

5 Challenges for Healthcare That Won’t Go Away

Posted on May 4, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There are some challenges in healthcare that will likely be with us forever. As soon as we think we have our arms around it, it grows or changes. It’s the nature of life and we have to constantly deal with these challenges as healthcare leaders. In a whitepaper titled “Healthcare Ops Management: 5 Trends You Can’t Ignore In 2016” 5 of these challenges are highlighted:
5 Healthcare Challenges
You can download the full whitepaper for free if you want to dive into more detail on each of these 5 challenges. However, it struck me that these 5 challenges are healthcare challenges that likely won’t go away:

  • Patients are Consumers
  • Patient Safety
  • Emergency Preparedness
  • Data-Rich Environment
  • Emphasis on Cost Reduction

Think about the list above. Will patients become less consumers? Will patient safety ever become less of a concern? Disasters are only picking up, so will we ever not need to prepared for emergencies? Can anyone imagine healthcare having less data? Would a leader ever say to not worry about cost reduction?

All of these challenges (and likely others) are things that healthcare leaders are going to have to deal with going forward. I wonder how many healthcare CIOs have a plan for how they’re going to prepare their organization for each of these challenges on an ongoing basis. I’m sure many have some point projects, but likely lack an overall vision for each of these areas. A plan for each of these 5 challenges would be a great place to start.

EHR Alerts, Top 10 Health IT Topics, Gesture Based EHR, and Adverse Events

Posted on December 18, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I thought it might be valuable to highlight a few interesting tweets I’ve seen recently. Some of them come from the other Healthcare Scene blogs, but I think you’ll find interesting.


Have alerts helped your organization? Alert fatigue is a very real thing, but when calibrated effectively, I’ve seen them really benefit an organization.


This is a fun list of healthcare topics. Do you see any topics that should be added to the list?


We’ve heard about gesture based EHR many times before. Mostly in the surgery room and mostly as demonstration projects. I don’t think this will really go huge and mainstream in healthcare, but could likely get some pickup for very targeted use cases.


Carl does a really great job in this article talking about Adverse Events and the legislation that’s proposed around EHR adverse events. This is a really important topic that doesn’t get nearly enough attention.

Patient Safety Benefits of EHR, EHR Design, and RIP CCHIT

Posted on November 7, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Here’s a quick look at some interesting tweets out their in the healthcare IT and EHR Twitterverse.


I’ve heard this argument from Epic before. There’s certainly an argument to make for improved patient safety on one system. However, that’s likely because our current systems aren’t interoperable. If they were interoperable, then having one massive system wouldn’t be better for patient safety. Considering, the EHR world is going to be a heterogeneous EHR environment, we need to make it so multiple systems isn’t a patient safety issue.


Ouch! I’ve described them as big billing engines, but I think a tool designed for insurance auditors might be more descriptive. Lately there has been a new layer added. EHR is now a tool for meaningful use auditors as well.


CCHIT being gone won’t likely have much impact on healthcare and EHR. They were basically gone for a number of years already. Although, I think their departure is a good thing for healthcare IT and EHR. I’d just still love to see EHR certification disappear as well. EHR certification is not meaningful.

Biggest Threat to Patient Safety – EMRs and Hospital Handoffs?

Posted on April 28, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This tweet should drive an interesting discussion. Dr. Val tweeted that the two biggest patient safety threats are EMR and hospital handoffs.

In the links, a lot of the things discussed are issues that could happen even outside the electronic environment. However, with every change in system, there’s an opportunity for the users to abuse that system.

As I’ve said before, EHR requires change (not to mention managing EHR change). That’s just a feature of an EHR implementation and it’s something we should embrace. However, one challenge with change is that many of the systems we’ve created that deal with the weaknesses of our current workflow don’t work with the new EHR workflow.

The problem when change occurs is that we often don’t remember to also change the processes we created to ensure things like quality. We assume that this new tech system will somehow magically solve the problems that we’d been having before. In some cases, the technology can solve your problems. For example, if your office had a problem with doctors writing illegible notes in the chart. EHR will solve that immediately. However, if you have a doctor who doesn’t document the visit fully in the paper chart, do you think the EHR Is magically going to solve it? No, you still need programs and policies that improve the quality of your clinical documentation.

Back to EHR as a major threat to patient safety, it’s very true. Although, it’s not the EHR itself that’s the problem. It’s what we do or don’t do with the tool that causes the issues.

A Culture of Patient Safety

Posted on March 27, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

One of the challenges with some health IT organizations is that they weren’t built from the ground up with a culture of patient safety in mind. There are certain aspects of an organization that need to become embedded in their culture for them to be a reality. Patient Safety is one of them. Privacy and security are another example.

The beautiful part is that once patient safety, privacy, security, etc become an embedded part of your culture, then amazing results happen.

Today I came across this incredibly compelling blog post on the Virginia Mason blog titled, “Terrible tragedy – and powerful legacy – of preventable death.” I love when hospitals are open and transparent like Virginia Mason is in that blog post. Ironically, their blog post is about transparency at an organization and the benefit to the organization. However, this line from the blog post struck me:

“Our board said that if we cannot ensure safety of our patients we shouldn’t be in business.”

-Cathie Furman, RN

This is a powerful question that makes me wonder how many companies shouldn’t be in business.

Ross Koppel Poses Questions About Safety and Usability of Health Information Technology

Posted on May 25, 2012 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was told that Ross Koppel gave a presentation at the NIST conference on EMR usability. In his presentation he covers several important issues of data entry and its impact on patient safety. In particular, he talks about a study he did on the problems of bar codes he found in hospitals. Turns out there’s a presentation by Ross Koppel on YouTube that is close to what he presented at the NIST Conference. See embedded video below:

Ross Koppel brings up some interesting points about patient safety and health IT. What do you guys think of his presentation?

Industry Does Too Little, Too Late On HIT-Related Safety Issues

Posted on November 11, 2011 I Written By

Anne Zieger is veteran healthcare branding and communications expert with more than 25 years of industry experience. and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also worked extensively healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

This week, a pair of HIT organizations — including a HIMSS-backed group and an alliance focused on HIT safety — came together to help track HIT-related patient safety problems. The two groups have broad-based vendor support, and they seem to have the right goals. Unfortunately for them, though, the HIT safety ship may have already sailed.

Participants in the current linkup include the iHealth Alliance, part of the  EHR safety group EHRevent.com run by the publishers of the Physicians’ Desk Reference, and the HIMSS EHR Association, a collection of 44 EHR vendors working together to work on key industry issues.

The safety group, which offers a quick form allowing people to report EHR-related safety concerns, is an official, federally-certified Patient Safety Organization. That gives providers the chance to report such events in a privileged, confidential manner.

That being said, regulators seem to have gotten the jump on the software folks. As some of you may know, regulators are already preparing to begin, well, regulating HIT safety results. The FDA, which issued draft guidance on mobile medical apps this summer, may cast its eye on EHRs at some point.

Another possible angle comes from the Institute of Medicine, which recently issued a report recommending that HHS create a new watchdog agency investigating health IT safety issues.  National Coordinator for Health IT Farzad Mostashari recently told reporters that his agency, the ONC, has already begun developing an EHR safety and surveillance plan which should be out within the next 12 months.

(If you want this process to be as painless as possible, you’d better hope that the IOM gets its way; vendors, you don’t want to face the kind of FDA struggles pharmaceutical companies do, right?)

Honestly, someone who’s watched regulators do their thing for decades, I’m betting this latest industry effort will be too little, too late.

Folks, as I see it the only way you’ll get the agencies off your back is to start reporting on safety issues with EMRs/EHRs and other health IT tools aggressively. But given that many organizations aren’t even at the stage where their EMR installation is stable, good luck!