Question

Discuss the risks a healthcare organization would face if they were to fail to allocate sufficient support and resources to a newly implemented healthcare information system. Provide support for your rationale.

Answer 1

From pandemics to violence in hospitals, alarm fatigue to healthcare-acquired infections, healthcare organizations will be put to the test in the coming months and years.

Added pressure from new regulatory requirements under the Affordable Care Act makes the future even more challenging

When you factor in the daily demands healthcare organizations face in their quest to provide quality patient care, it’s clear that there are many hurdles that can disrupt facility operations and put employee and patient safety at risk.

”Today’s healthcare landscape is arguably the most difficult ever,” said Diane Doherty, Vice President, ACE Medical Risk Group. “If not managed properly, these critical issues can cause other unwanted outcomes such as an increase in medical malpractice and workers’ comp claims, government fines and penalties, and may negatively impact the organization’s brand and reputation.”

The following are some of the top critical issues facing hospital leadership.

1) Cyber Risk

The healthcare industry’s move to electronic healthcare records has created new patient privacy exposures as records are more easily accessed by consultants, vendors and other third parties for efficient operation, and targeted by cyber criminals. Additionally, healthcare organizations face exposure to cyber risks that could have significant impacts on their operations, including shutting down critical, health-related systems.

Data breaches and network disruptions can jeopardize an organization’s financial stability, security and reputation. Standard general liability policies often do not adequately cover perils associated with cyber and technology related exposures. Cyber liability insurance can address coverage gaps while also enabling companies to transfer risks associated with cyber, such as patient privacy and notification, crisis management, and forensic analysis expenses as well as certain regulatory fines, indemnity payments and legal costs.

“Cyber hacks and data breaches are a major issue facing the healthcare industry today,” said Renee Carino, Vice President and Chief Underwriting Officer, ACE Medical Risk Group. “It’s important now more than ever, that healthcare organizations work closely with their insurance carrier to assess this exposure and develop effective risk management strategies and ensure the proper coverage is in place.”

2) Healthcare Infections

Healthcare-acquired infections (HAIs) cost the U.S. healthcare system billions of dollars each year and lead to the loss of tens of thousands of lives. At any given time, about 1 in 25 hospital patients has at least one such infection, according to the Centers for Disease Control and Prevention. Healthcare-acquired infections also come with a financial price, costing up to $9.8 billion a year, according to research published in 2013 in JAMA Internal Medicine.

Among many solutions, healthcare organizations should ensure all sanitation systems are up to date, operational and ensure that staff understands how to properly use the systems to keep patients safe. They also should continue to remind staff and visitors about basic infection control techniques.

“Basic infection control techniques should be at the forefront of the risk management process,” said Doherty. “For example, it’s critical that medical personnel must wash their hands with antiseptic soap and water every time they treat patients to help reduce the spread of infections.”

3) Telemedicine

Advances in technology, the current physician shortage and the dramatic increase in the number of patients seeking care under the Affordable Care Act have led a growing number of healthcare facilities to expand their use of telemedicine to deliver services to patients in hospitals as well as in remote locations. Over half of all U.S. hospitals now use some form of telemedicine to treat patients.

Telemedicine may also result in allegations of negligence if healthcare providers do not have the proper training, experience and credentials. Currently, there is no federal standard of clinical guidelines for telemedicine.

In developing strategies to mitigate this risk, a few key processes and areas that should be examined include credentialing and peer review, medical staff by-laws and of course, CMS guidelines.

4.Violent Incidents in Hospitals:

Hospitals may be places of healing, but they also have become the scene of an increasing number of violent incidents. Such incidents not only put patients at risk but also medical professionals, who are often the targets of attacks, harassment, intimidation and other disruptive behavior.

The incidence rate for violence and other injuries in the healthcare and social assistance sector in 2012 was over three times greater than the rate for all private industries. The Joint Commission, meanwhile, reports increasing rates of assault, rape and homicide in healthcare facilities. Perpetrators can include patients, family members, visitors and vendors as well as current and former healthcare employees.

Hospitals and healthcare organizations should enact a zero-tolerance policy, one that states that no form of violence — physical, verbal or psychological — will be tolerated, and that all offenders will be subject to disciplinary action, including termination.

“Healthcare organizations should develop a comprehensive violence prevention program that is specific to their organization and analyzes potential safety hazards and implements strategies to prevent them,”

5) Alarm Fatigue

Hospital nurses hear them constantly — the beeps and chirps of alarms on medical devices, such as ventilators, cardiac monitors and pulse oximetry devices. While alarms are designed to draw attention to a potential problem, they can easily be tuned out by overwhelmed medical professionals, who may then fail to respond as they should.

Alarm fatigue is a growing problem for hospitals and the consequences can be fatal. The Joint Commission’s Sentinel Event database includes reports of 98 alarm-related events between January 2009 and June 2012. Of the 98 events, 80 resulted in death, 13 in permanent loss of function and five in unexpected additional care or extended stay. Alarm fatigue was rated a top concern by 19 out of every 20 hospitals in the United States, according to a national survey presented at the annual meeting of the Society for Technology in Anesthesia in 2014.

To reduce the risk of patient harm from alarm fatigue, the Joint Commission, along with the Association for the Advancement of Medical Instrumentation and the ECRI Institute, offered a list of precautions, including ensuring that there is an effective process in place for safe alarm management and response in high-risk areas.

Poor Accommodation of Patients’ Needs

Americans are living longer, in part as a consequence of advances in medical science, technology, and health care delivery. As the population ages, there will be more patients with chronic conditions. In 2000, about 13 percent of the population (35 million Americans) were over age 65; this proportion is expected to rise to 20 percent (70 million) by 2030 (National Center for Health Statistics, 2002). An estimated 125 million Americans already have one or more chronic conditions, and more than half of these people have multiple such conditions (Wu and Green, 2000).

Moreover, although the majority of disease burden and health care resources is related to the treatment of chronic conditions, the nation’s health care system is organized and oriented largely to provide acute care and is inadequate in meeting the needs of the chronically ill (Wagner et al., 2001). As William Richardson, Kellogg Foundation, noted in his remarks at the summit, “There are few clinical programs that can provide the full complement of services needed by people with heart disease, diabetes, asthma, or other common chronic conditions (Richardson, 2002).

Studies show that effective treatment of chronic conditions needs to be continuous across settings and types of providers. Clinicians need to collaborate with each other and with patients to develop joint care plans with agreed-upon goals, targets, and implementation steps. Such care should support patient self-management and encompass regular clinician follow-up, both face-to-face and through electronic means (DeBusk et al., 1994; Von Korff et al., 1997; Wagner et al., 2001; Wagner et al., 1996). Clinicians practicing in such an environment need to be effective members of an interdisciplinary team, provide care that is patient-centered, and be proficient in informatics applications.

A recent survey underscored issues faced by the chronically ill, with about three of every four respondents reporting difficulty in obtaining medical care. Specifically, 72 percent had experienced difficulty in obtaining care from a primary care physician, 79 percent from a medical specialist, and 74 percent from providers of drug therapy (Partnership for Solutions, 2002b). This same survey indicated that, as a result of the lack of coordination, the chronically ill were receiving spotty or contradictory information and facing avoidable complications. At the summit, Mary Naylor described a typical real-life example of the lack of coordination for the chronically ill:

A 75-year old woman…had a number of chronic conditions: osteoporosis, hypertension, diabetes, and heart failure, and… was admitted to a hospital as a result of a fall…and fracture…. We followed her…from hospital admission, through one month’s time, and she was the subject of about 20 major providers. That does not include the numbers of ancillary personnel and other support people involved in her care. While hospitalized, she interacted with an orthopedic surgeon and his team, a cardiologist, an endocrinologist, a primary care nurse, a physical therapist based in the hospital, and a social worker who helped facilitate her discharge to a skilled nursing facility. At that point, the hand-off was to a physician in the skilled nursing facility, a physical therapist, an occupational therapist, and a variety of other providers. Within 2 weeks’ time, she was returned home to home care follow-up by the Visiting Nurse’s Association, and had a nurse, occupational therapist, and physical therapist engage with her in care in the home.

• Poor systems design has led to errors, poor quality of care, and dissatisfaction among patients and health professionals.
• The needs of the chronically ill are not being adequately met. Addressing those needs requires the reform of systems of care and greater coordination and collaboration among health professionals, as well as more attention to prevention and the behavioral determinants of health.
• Technological advances in information technology and an expanded evidence base gained from research on clinical practice have the potential to transform health care, but such advances have not been adequately harnessed.
• Patients and consumers are now increasingly informed about their health. As a result, there is a need for a new relationship of shared decision making between patients and health care providers. Providers also need to be more attentive to patient values, preferences, and cultural backgrounds.
• Workforce issues related to shortages and effective deployment of existing professionals need to be addressed before quality of care is further compromised.
• Health care employers and recent graduates cite gaps between the way health professionals are prepared and what they are called upon to do in practice, gaps that are attributable to many factors, including a lack of funding to revamp curricula and a limited focus on teaching in academic health centers.

The Quality Chasm report, echoed by each of the plenary speakers at the summit, calls upon the clinical education community to provide transformational leadership in response to the challenges outlined above. At the summit, Don Berwick, Institute for Healthcare Improvement, described the purpose of the health care system—initially articulated by the President’s Advisory Commission on Consumer Protection and Quality in the Health Care Industry—as continually reducing the burden of illness, injury, and disability and improving the health status and functioning of the U.S. population. He added:

The success of the American professional [health] education system is its ability to achieve this and nothing else. It’s asking the American [health] professional education community to adopt this as ‘true North’ (Berwick, 2002).

Also at the summit, Ken Shine called upon health professionals to establish themselves as leaders on behalf of the American people by improving the quality of care. He added:

Doing that is not just a self-serving activity. It’s one which all of society will cherish and benefit from, and I believe it’s a message which our students will respond to if they are properly motivated and have the proper insights (Shine, 2002).

These statements were intended to be a catalyst for health summit participants as they identified strategies and actions at both the institutional and environmental levels for bringing about educational reform in line with the vision for a 21^st-century health system set forth in the Quality Chasm report. Don Berwick acknowledged the tremendous difficulties involved in bringing about change in the environment of health care and clinical education, but underscored the importance of the effort:

You can’t just say the environment won’t let you do it. You just can’t. It’s passing the buck a step beyond what a proud set of professionals ought to be doing. We need to own it. We need to change it. We just need to change it. And if the environment is throwing us a curve ball, we just need to learn how to hit curve balls.