How EHR data can bolster quality improvement process review

Personal Health Record

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Electronic health record data can identify gaps in maps used for quality improvement for high-risk processes such as hospital discharge when using the Failure Mode and Effects Analysis (FMEA) approach, a new study has found.

FMEA uses process maps of clinical workflows for risk assessment to identify ways a particular process might fail and where those points of failure might be. It relies on topic experts and clinical representatives who map out each step and who is expected to perform it, according to the research published in the Journal of the American Medical Informatics Association.

The researchers, from Northwestern University and elsewhere, extracted data on admissions to a cardiology unit and formed a mock committee to develop a FMEA process map for patient discharge. They then compared who was expected to perform each task with what the EHR data revealed about it.

However, gaps in knowledge and experience might lead to errors, the researchers add.

They note that the EHR generates information about daily workflow including names, titles, times and activity details. It can help identify people who most frequently perform a process and might have the most knowledge of problems that could occur.

And while an organization might try to pinpoint who has the most important insight into a process, the EHR might help identify those with other perspectives.

In this research, 35 percent of tasks were completed by people other than those listed on the process map, including people in 12 categories not identified as part of the discharge workflow.

The EHR data also showed some tasks listed as one activity on the process map were made up of multiple components completed by different people, and that some of these sub-components did not appear on the process map.

They concluded that using EHR data might strengthen the FMEA process and might be useful for other quality improvement initiatives as well.