EHRs can provide more thorough info for quality improvement activities


Electronic health records can be leveraged to improve process maps used in failure mode and effects analysis (FMEA) and other programs to improve patient safety, according to a new study in the Journal of the American Medical Informatics Association.

FMEAs identify flaws in high-risk processes, analyze how a process may fail and prioritize interventions before patient harm occurs. They utilize process maps to identify people and activities involved in a clinical workflow to be used in the analysis.

The more accurate and complete a process map is, the more likely that it will lead to stronger quality improvement. EHRs provide a new opportunity for strengthening process maps because they can aid in identifying people involved in a high-risk process and activities where the clinical perception of the provider who performs it differs from the reality of the situation.


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The researchers studied discharges from the inpatient cardiology unit at Northwestern Memorial Hospital between July 1, 2014 and Dec. 31, 2014, reviewing 34,939 activities across 2,222 encounters, comparing a process map of activities and involved individuals that had been created to the EHR data.   

They found the EHR data was more detailed. For instance, while the process map contained seven provider categories, the EHR identified 19. The EHR also identified discharge sub-processes not included in the process map, such as orders, notes and forms. Moreover, 35 percent of the activities were completed by “unexpected” providers.  All of this additional information can represent perspectives that might have been missed during FMEA based on the process map alone.

“EHR data may reveal gaps in process maps used for quality improvement and identify characteristics about workflow activities that can identify perspectives for inclusion in an FMEA. Organizations with access to EHR data may be able to leverage clinical documentation to enhance process maps used for quality improvement," the authors wrote. "While focused on FMEA protocols, findings from this study may be applicable to other quality activities that require process maps."

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