28 Jun Human factors and IT: Designing for patient safety
MADISON – In the medical profession, one of the greatest obstacles in taking care of a patient is the overflow of information that naturally accompanies treatment. Patient histories and care instructions are often long and full of irrelevant information, and if multiple hospitals are involved, more levels of complication develop. To many, a technological system that could organize all this information seems like a Holy Grail, a treasure for doctors and patients alike.
This system was a main topic of conversation at last Wednesday’s Digital Healthcare Conference, culminating in a case study on information technology presented by Paul Smith and Pascale Carayon. Combining Smith’s experience at the UW Medical Foundation with Carayon’s as a professor of industrial engineering at the University of Wisconsin-Madison, their studies took them “in the trenches” of a small clinic. Carayon and Smith studied the effects of implementing electronic medical records (EMRs) on employee productivity and patient care, as well as the principles for applying such a system in a medical setting.
“There are a lot of human factors ranging from safety and technology, from patient safety to nurse’s workload – so its possible mistakes are made,” Carayon said. “We will be talking at a very local level, [studying] errors committed by designers and engineers.”
Carayon began with a basic outline of EMRs, explaining the technology allows for a patient, doctor and computer to all be in the same room during treatment, creating immediate data updates. The information is then stored in the EMR and is accessible at any other session with the patient, but kept separate from other records to limit confusion. The system itself has great potential to reduce errors and improve care, although has several roadblocks – both financial and institutional – in its path.
To test just how strong these roadblocks are, Carayon and Smith chose to apply the system at the Belleville Family Medicine Clinic; a private clinic with a staff of approximately 25 physicians and support personnel and an average of about 12,000 patient visits per year. The system – which had the goal of linking every exam room to the EMR database – was implemented in November 2000 following data collection the previous spring. Focusing on employee attitudes and time analysis, the collection was repeated in 2001 to see how characteristics of technology affected the quality of working life.
“Technology is not completely neutral – it will change the job they do,” Carayon said of the EMRs. “The technology may improve efficiency but it can [also] create inefficiency.”
After the system was implemented and users polled, Carayon and Smith discovered from employee questionnaires that while the information on the system and input on design and implementation had gone up, so had the dependence on the system by almost 20 percent. Carayon cautioned against developing too much dependence on the system, as there are definite repercussions, such as the entire clinic grinding to a halt when the system crashes.
The studies then turned to time analysis, looking at each job category and breaking down the individual tasks by activity, function and contact. According to the studies, time spent in basic preparation around the hospital had gone down from 23 to 15 percent, while time of computer entry had increased from 19 to 30 percent. However, Carayon was also able to point out that care of patients went up from 28 to 39 percent with the EMR system functional, and time spent on activities such as telephone and dictation went down at least 5 percent as computers took over the tasks.
“To us, technology is a tool that is designed and implemented,” Carayon said. “The staging and results are really important … keeping end users in is a key factor.”
Smith then took over the presentation by stressing the key principles behind establishing an EMR system, from getting started to follow-up research. To begin a process, it is necessary to “buy in at the highest level” and secure financial support from CEOs and upper management or the project will never get off the ground. Communication is also vital in the early stages because it’s through live demonstrations and frequent notices that the project can come to the attention of those “power users” who are in a position to help.
It is also important for the users to get involved at all stages of the project, as it is their lives that will be the most directly influenced by changes. Smith emphasized that no change should be made unless necessary, and stresses that accompany change should not be addressed up front because it causes more problems than it fixes. The only thing to move quickly into is follow-up so information can be acted on while fresh.
“As policies are developed, there are things that need to be taken into consideration,” Smith said of forming an IT system. “We wanted people to get [their] job done, and we’ll move to the fancy stuff later.”
Smith ended by cutting to what he said was the primary factor in adapting any new technology: simply make sure it works, and that it makes an existing process either faster or easier for those using it. Drawing a comparison between users and a hamster on a wheel, he said that people are naturally used to going faster and faster and anything that does not keep up will fail.
“If you can’t design a system that does that, they are not going to use it,” Smith said. “The needs for data, how fast data changes … we try to give [users] as many options as possible.”
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Les Chappell is a staff writer for the Wisconsin Technology Network and can be reached at les@wistechnology.com.