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.

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.

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.

If you’ve been following medical device safety issues this year, there’s a good chance you’ve seen the headlines about patient injuries and deaths related to internal surgical staplers. The devices are commonly used in many high-risk surgical procedures. Misuse and malfunction of surgical staplers can lead to serious complications—as we’ve seen during our own research and accident investigations.

The stapler cases we investigate tend to be associated with serious injuries or fatalities, some of which could have been prevented. The overall adverse event rate is low relative to the number of times staplers are used; however, cases of preventable death are chilling. This has led ECRI Institute to thoroughly research and evaluate staplers and to publish safety hazards to our members. In fact, surgical staplers have appeared twice on our annual list of Top 10 Health Technology Hazards— first in 2010 and again in 2017.

So, why is this decades-old technology in the news now? And, more importantly, what can you do to keep patients safe?

In late 2017, a catastrophic medication error led to a patient death at Vanderbilt University Medical Center. While waiting for a PET scan, an elderly woman was incorrectly administered vecuronium, a paralyzing neuromuscular blocker, rather than the prescribed sedative Versed. It was reported that, because vecuronium suppresses normal respiration and the patient was left unattended while waiting for the test, she suffered cardiopulmonary arrest. Although she was resuscitated, it was too late to prevent brain death, and she was later removed from life support.

This case was widely reported in the media as an example of preventable medical errors that injure or kill too many patients, despite our efforts to make healthcare safer. As we reach the 20-year anniversary of To Err Is Human, the landmark Institute of Medicine report that crystalized the patient safety movement in the U.S., we must humble ourselves with the knowledge that while we’ve made many improvements, there is still much more work to do.