1IT Did Its Job in Dallas – But What About the Human Factor? 1Health IT Is Only a Portion of the Solution – Addressing Human Factors Are Key  
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3Posted on October 3, 2014        by Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN2Posted by Joyce Sensmeier, MS, RN-BC, CPHIMS, FHIMSS, FAAN
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5Many headlines appeared today citing the failure of health information technology in the release of the patient with Ebola from a Texas hospital.3Many headlines appeared today citing the failure of health information technology in relation to a patient with Ebola being released from a US hospital.
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7Electronic-Record Gap Allowed Ebola Patient to Leave Hospital - Bloomberg News5Electronic-Record Gap Allowed Ebola Patient to Leave Hospital - Bloomberg News
8EHR flaw at core of US Ebola case – Healthcare IT News6EHR flaw at core of US Ebola case – Healthcare IT News
9We are all paying very close attention to the situation and the role health IT may have played in determining the proper Ebola diagnosis.  As we understand the circumstances, the separation of nursing and physician notes in the electronic record may have contributed to a lack of cross-team knowledge sharing.  Communication in a busy emergency room, and between clinicians in any patient care setting, is vital to providing quality care.  And health IT is only one solution. 7As we understand the circumstances to-date, the separation of nursing and physician notes in the patient’s record may have contributed to a lack of cross-team knowledge sharing.  This presents an opportunity to explore the role health IT can, or should, play in determining a clinical diagnosis.
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9First and foremost, communication is vital to providing quality patient care – whether in a busy emergency room or in a doctor’s office.  Clinicians must be able to share information with each other across clinical disciplines and with their patients.  Health IT is only one solution to the goal of cross-team knowledge sharing.
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12The IT system at Texas Health Dallas did the job it was designed to do.  Can it be improved?  Absolutely, and it appears that they are working on that. Greater levels of implementation of key clinical IT applications can provide the opportunity for clinicians to have improved access to the information they need at the patient’s bedside in order to provide quality care. But health IT is only “20 percent” of the solution. To have a transformed health system in which the right information is available at the right time to the right people to make the right decisions requires the “other 80 percent,” which is:11Greater levels of implementation of key clinical IT applications can offer the opportunity for clinicians to have improved access to the information they need at the patient’s bedside to provide quality care. Using the cliché of the 80-20 rule, health IT is only “20%” of the solution. A transformed health system in which the right information is available at the right time to the right people to make the right decisions requires the “other 80 percent,” which is:
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14workflow evolution,13workflow evolution,
15interprofessional communication, and14cross-clinical-discipline communication, and
16change management.15change management.
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18Research conducted during the 10-year period of 1995-2005 has demonstrated that ineffective team communication is the root cause for nearly 66 percent of all medical errors. In fact, when healthcare team members do not communicate effectively, patient care often suffers.[1]17Research conducted during the 10-year period of 1995-2005 has demonstrated that ineffective team communication is the root cause for nearly 66 percent of all medical errors. In fact, when healthcare team members do not communicate effectively, patient care often suffers. (1)
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20To better assess the impact of health IT on communication, HIMSS & HIMSS Analytics replicated the 2006 iHIT Nursing Study. The 2013 study explores the ability of health IT to provide enhanced access to clinical information needed to support patient care from an interprofessional perspective of nurses, pharmacists and physicians.19To better assess the impact of health IT on communication, in 2013 HIMSS & HIMSS Analytics refreshed and resurveyed an iHIT Nursing Study instrument from 2006. The 2013 study explores the ability of health IT to provide enhanced access to clinical information needed to support patient care from an interprofessional perspective of nurses, pharmacists and physicians.
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22HIMSS 2013 iHIT Study – Executive Summary21HIMSS 2013 iHIT Study – Executive Summary
23HIMSS 2013 iHIT Study – Infographic22HIMSS 2013 iHIT Study – Infographic
24HIMSS 2013 iHIT Study – Final Report23HIMSS 2013 iHIT Study – Final Report
25Study Results show:24Study results show:
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27General advantages of HIT: 70 percent of respondents were likely to note that HIT benefitted their overall ability to provide care efficiently, including the ability to have the information needed to understand their daily caseload.26General advantages of HIT: 70 percent of respondents were likely to note that HIT benefitted their overall ability to provide care efficiently, including the ability to have the information needed to understand their daily caseload.
28Workflow implications of HIT: There is a high level of agreement (83 percent) among survey respondents regarding the role that HIT can play relative to the support of clinical processes, including the ability to provide quality care.27Workflow implications of HIT: There is a high level of agreement (83 percent) among survey respondents regarding the role that HIT can play relative to the support of clinical processes, including the ability to provide quality care.
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30Information provided by HIT: 80 percent of respondents were highly likely to indicate that the information provided through the HIT tools available at their organization helped clinicians process data and improved access to information needed to provide safe patient care.28Information provided by HIT: 80 percent of respondents were highly likely to indicate that the information provided through the HIT tools available at their organization helped clinicians process data and improved access to information needed to provide safe patient care.
31However, and perhaps most relevant to this situation;29However, and perhaps most relevant to this situation;
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33Assurance between colleagues: Only half of respondents indicated that the acknowledgement features of the HIT tools at their organization provide adequate assurance that interdisciplinary colleagues are receiving appropriate communications.31Assurance between colleagues: Only half of respondents indicated that the acknowledgement features of the HIT tools at their organization provide adequate assurance that interdisciplinary colleagues are receiving appropriate communications.
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35I began my nursing career working with patients in a hospital in the Chicago area. Then, as now, one of the most vital steps of delivering quality care is communication:  talking to the nurses on the previous shift, and then explaining patient needs to the incoming clinical team. Reliance on health IT does not make that interprofessional communication any less important.33I began my nursing career working with patients in a hospital in the Chicago area. Then, as now, one of the most vital steps of delivering quality care is communication: talking to the nurses on the previous shift, and then explaining patient needs to the incoming clinical team. Reliance on health IT does not make that interprofessional communication any less important.
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37Situational awareness in any patient care setting, especially in an emergency department, requires timely, cross-team communication. The global concerns around Ebola should only heighten that awareness. Health IT may play a role, but at the end of the day it is the professionals who communicatin care settings that are vital to providing quality care.35Situational awareness in any patient care setting, especially in an emergency department, requires timely, cross-team communication. The global concerns around Ebola should only heighten that awareness. Health IT may play a role, but at the end of the day, it is the professionals, clinicians, and patients communicating with each other in care settings that are vital to providing quality care.
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39[1] (Team strategies and tools to enhance performance and patient safety (TeamSTEPPS), Department of Defense and Agency for Healthcare Research and Qualityhttp://www.ahrq.gov/qual/teamstepps/)‎39(1) (Team strategies and tools to enhance performance and patient safety(TeamSTEPPS), Department of Defense and Agency for Healthcare Research and Qualityhttp://www.ahrq.gov/qual/teamstepps/)‎