Because of the informatics transformations happening concurrently with so many mergers of providers and health systems, IT platforms must necessarily be merged alongside them. The 2015 merger of two major healthcare systems in the Chicagoland area, Cadence Health and Northwestern Memorial HealthCare, is among the latest examples of this complex, large-scale puzzle.
Dr. Thomas Moran, VP and chief medical information executive for the merged system, Northwestern Medicine, has shepherded this informatics merger, which involved seven hospitals, 100 diagnostic and ambulatory sites, and nearly 4,000 physicians.
Patient safety was of utmost priority in this merger process, addressing an issue seen in hospital systems across the United States. A study out of Johns Hopkins Medicine in 2016 revealed that medical errors in the US are the cause of 250,000 deaths per year, putting it as the number-three cause of death behind heart disease and cancer.
According to the study, those medical mistakes ranged from surgical complications that went unrecognized to mistakes in the dosing or types of medications that patients received. Each has aspects that are related to medical-information systems. The study authors concluded this isn’t a widely recognized problem because the coding system used by the Centers for Disease Control and Prevention does not capture such things as poor judgment, diagnostic errors, or communications breakdowns.
“The culture of an organization is what drives safety. Safety needs to be in the minds of everyone in the organization so that it becomes ingrained into our DNA.”
“To ensure safe care we need to look at workflows from the end user viewpoint,” says Moran, who strongly believes that providers can leverage technology to enable more efficient, safer care.
Those workflows are on the minds of healthcare providers and patients nationwide. An annual survey, “Top 10 Patient Safety Concerns for Healthcare Organizations 2016,” compiled by the ECRI Institute, puts this at the top of its list. “Health IT configurations and organization workflow that do not support each other” is a problem if “after the implementation, people continue to do things the same way and really don’t adjust the health IT system or their workflow,” according to Robert C. Giannini, patient safety analyst and consultant at the ECRI Institute.
Moran had addressed this in the clinical EMR merger. Merely utilizing an EMR is no guarantee it will be used without error. “The culture of an organization is what drives safety,” he says. “Safety needs to be in the minds of everyone in the organization so that it becomes ingrained into our DNA.”
Moran, an emergency medicine physician before becoming a medical director and then chief medical information executive, says that to facilitate this, they teach employees and caregivers specific safety behaviors.
“The computer cannot keep patients safe,” he continues. “The mere look and feel of orders within an EMR does not make the orders all correct for your patient. So the culture of safety has to be front of mind, and we must use these safety tools to keep the patient safe.” Embedding a culture of high reliability provides a structure to identify potential errors, and to take steps to prevent mistakes that can lead to patient harm.
Put another way, it still boils down to the “garbage in, garbage out” axiom. “Technology can assist, but safety is the responsibility of the clinical caregivers,” he says. “Findings show the incidents that caused harm to patients were often related to incorrect entry of data.” He lists what he calls the “sociotechnical link” that plays into the provider’s ability to maximize safety for patients.
“We need to build systems that take into account people, processes, technology, culture, and the users’ working environments,” Moran says. “This allows for safe, efficient workflows and the presentation of patient information—not just data, so clinicians are better equipped to keep us safe and care for us.”
Moran also stresses that a mature safety culture empowers people to speak up when they have concerns about patient safety, without fear of reprisal. Staff hold each other accountable for using safety protocols. By studying past mistakes, they can prevent them from occurring again in the future.
Moran’s job entails educating physicians and other users of clinical information, supporting teams that conduct clinical research and what he calls “outcomes management.” That includes the use of data analytics to study and ultimately make specific and systematic improvements in care delivery.
Moran began his informatics career in the Cadence Health system, which was a suburban community-based provider. Northwestern Memorial Hospital is a traditional academic medical center in downtown Chicago.
Integrating the informatics platform took work, but it enables an equal level of caregiving regardless of location in the sprawling system.
Moran engaged physicians in the merger at an early stage, something that consequently enabled them to align their workflows in the new system—to the benefit of care efficacy and patient safety.
Outside of the hospital, Moran oversees the MM Foundation, named for his deceased father, which sponsors pediatric cancer patients attending the TLC Camp, a summer camp in Lombard, Illinois. A team approach is part of the medicine here, too: the campers are joined by a sibling to share in the experience. AHL