Haphazard IT implementation increases potential for patient risk

There's a greater potential for patient harm when hospitals do not plan technology implementation, according to research published in the March issue of the American Journal of Managed Care.

Researchers analyzing 118 interviews at seven Veterans Affairs hospitals from June 2006 through September 2007 said that universal support from staff and executives is necessary during such rollouts, as is flexibility to work around potential setbacks.

Five themes impacting a hospital's IT implementation, as determined by the researchers, included:

  • Organizational stability and quality leadership
  • Solid timelines
  • Availability of reliable resources
  • Staff training
  • Workflow changes

"A successful HIT implementation requires substantial dedication of resources, particularly personnel resources," the authors said. "Healthcare leaders must expect that there will be setbacks during an HIT implementation, and must push through these setbacks thoughtfully and deliberately."

For example, every site examined experienced issues regarding bar code medication administration (BCMA) implementation to the point where medications were miscoded and "empty unit-dose packages" were delivered to wards.

"At some VA hospitals, staff were implicitly or explicitly permitted to use various workarounds with BCMA, such as typing codes directly into the computer or doing all scanning after medication administration," the authors wrote. "One manager noted, 'staff had to be given leeway to deal with things that did not work.'"

The authors say round-the-clock support and extra staff should be employed during new technology rollouts.

"Providers need a substantial amount of time to learn new methods of keeping patient records and administering medications," the authors write. "In general, this is a temporary requirement, and less time is spent on record keeping activities once the HIT system is established."

Such themes, and more, appear to have been taken into account by New York-based Montefiore Medical Center for its computerized physician order entry system, which CIO Jack Wolf recently talked about in an interview with Becker's Hospital Review. In addition to being one of the first hospitals in the nation to reach 100 percent implementation of CPOE, Montefiore's prescribing errors went down a whopping 85 percent upon implementation of its CPOE system.

Despite such success, however, Wolf believes that hospital administrators need to have backup systems ready at a moment's notice, especially in the case of electronic health record and CPOE systems.

"It is not a question of whether a problem will occur, but when will a problem occur," Wolf tells Becker's. "You have to test the backup system constantly because you will want to transition automatically without skipping a beat."

To learn more:
- here's the American Journal of Managed Care study
- read the Becker's Hospital Review interview

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