ECRI Blog

A Continuing Inside Look into the Partnership Workgroup on Optimizing Health IT for Safe Integration of Behavioral Health and Primary Care

"Integration" of behavioral health and primary care is a promising approach to enhancing care, enabling patient safety and improving quality. Technology-enabled tools, including electronic health records (EHRs), clinical decision support, and standards-based interoperability, can enable integration to achieve these goals.

When technology entered healthcare, so too did alerts. Alerts acted as attention grabbers, reminders, notices of changes in a patient's condition, and warnings about malfunctions or improper functioning. As technology grew more prevalent with the advent of automated dispensing cabinets, computerized provider order entry (CPOE), digital point-of-care monitors and devices, and electronic health records (EHRs), the number of alerts grew exponentially. Clinicians were exposed not only to their own patients' alerts, but to all of the alerts or alarms sounding within a particular unit. The number of per-patient alerts can be astounding. One facility determined that in its critical care unit, "between 150 to 400 physiologic monitoring alarms" sounded per patient, per day.¹ This cacophony is compounded by alerts triggered by electronic records.

An Inside Look into the Current Partnership Workgroup

COVID-19 anxiety is increasingly part of our everyday lives. The resulting disruptions in daily routines can create or worsen anxiety and raise other mental and behavioral health concerns. In the best of times, behavioral health conditions are often underdiagnosed and undertreated. According to Jetelina et al., every year "26% of the United States population experiences an emotional, mental, or behavioral health problem."¹ In addition to the current events triggering these conditions, behavioral health issues can also be associated with chronic medical conditions such as diabetes,² cardiovascular disease, and substance use disorder (SUD).³

Infection prevention is of vital concern right now, and reducing disease transmission between healthcare workers (HCWs) and patients is critical for patient safety. 

One source of danger to patient safety is infection from healthcare workers who wear artificial nails or nail polish.

Appropriate policies are required to help mitigate infection risk in hospitals and other healthcare settings. HAIs are a concern not only in hospitals; infections can be acquired in any healthcare setting (e.g. physicians’ offices, clinics, dialysis facilities, nursing homes, and rehabilitation centers) when patients encounter bacteria, fungi, or viruses while receiving treatment for unrelated conditions.

The seeds of an adverse drug interaction can be planted at any point in the care process, by any of the individuals involved. For instance, take a look at these common scenarios:

• A clinician, overwhelmed by meaningless alerts, overrides a warning and misses crucial information about a patient's drug allergy.
• A physician office's electronic health record (EHR) system enters the correct drug allergy information, but the pharmacist is unaware of the information.
• A young adult patient is allergic to an antibiotic, but doesn't know exactly what happened when he took the antibiotic as a child and he doesn't mention it when being treated for pneumonia.

The chances that any one of these situations may occur is increasing.

Ethylene oxide (EtO) sterilization has been in the news a lot lately, and healthcare has much at stake. According to officials at the U.S. Food and Drug Administration (FDA), approximately 56% of all critical medical devices are sterilized using industrial EtO sterilization. Currently, there are no validated industrial alternatives, so additional closures of EtO processing facilities would have the potential to impair the U.S. healthcare system.

While some state legislators are considering bans on industrial EtO sterilization facilities, healthcare leaders, manufacturers, and FDA have been reviewing options to ensure the availability of sterile medical devices and supplies necessary for patient care.

In the United States, there are 30 times more outpatient visits as hospital discharges. As a result of the high volumes and complexities inherent to ambulatory settings, one in twenty patients can expect to experience a diagnostic error in their lifetime. According to the Agency for Healthcare Research and Quality, 55 percent of patients said that diagnostic errors were a chief concern to them. 

Earlier this fall, ECRI Institute Patient Safety Organization took an in-depth look at patient safety events in ambulatory care, specifically physician practices and healthcare clinics. Nearly half of the 4,355 analyzed events were related to diagnostic testing. Errors that occur during diagnostic testing can have potentially devastating consequences for patients. The majority of these events occurred after tests had taken place, often due to a gap in communication.

Editorial Note: This blog was also co-authored by Shari Medina, MD, of Harris Healthcare, chair of EHRA’s Patient Safety Work Group who led the Partnership for Health IT Patient Safety’s workgroup on this joint project; and Mark Segal, PhD, FHIMSS, principal, Digital Health Policy Advisors.

The United States is in the midst of an opioid use epidemic. Patients, providers, pharmacists, pharmaceutical companies, and electronic health record (EHR) developers have each been highlighted for their role in responding to the crisis. This blog focuses on the role of health IT in particular, and the safe practices that can be put in place for opioid prescribing.

As conveners of the Partnership for Health IT Patient Safety, a multi-stakeholder collaborative, ECRI Institute sees a very important role for developers of EHRs and other health IT in promoting opioid-related patient safety. Employing health information technology (IT) for early identification of at-risk patients and for safer prescribing can promote more efficient deployment of preventive resources and help reduce the risk of persistent opioid use or abuse.

Anti-microbial resistance (AMR) presents serious global concerns, now and in the future. The World Health Organization (WHO) lists AMR as a top ten threat to public health. Last year, there were 700,000 deaths worldwide from AMR. That number is expected rise to 10 million a year in 2050—more lethal than cancer—if we fail to change what we are doing today.

Google the term “superbug” and you’ll see close to 4,000,000 hits. The rise of superbugs—microbes resistant to powerful drugs—led the Centers for Disease Control (CDC) to create the AMR Challenge, a year-long effort to accelerate the fight against antimicrobial resistance across the globe. CDC mobilized commitments from more than 270 countries and organizations around the world, including my organization, ECRI Institute. Action-based commitments are key. Without action, many nations risk slipping back into the pre-antibiotic era, compromising the success of major surgery, cancer chemotherapy, and other health care—and serious economic impacts, too. 

After heart disease and cancer, medical errors are the third leading cause of death in the United States and include misdiagnoses, incorrect anesthesia, delayed treatment, and patient misidentification.

Patient identification has been on the minds of healthcare leaders and policy makers for more than two decades. When the Health Insurance Portability and Accountability Act (HIPAA) was signed into law in 1996, it called for developing a national patient identifier that would solve patient misidentification by assigning a unique, permanent number to every individual in the United States. The idea was to implement a uniform approach for accessing a patient’s medical history across the healthcare system. After HIPAA became law, Congress blocked this effort over privacy concerns, and the issue gradually faded from public attention.