I was pleasantly surprised when I picked up my paper this morning to learn that the University of Wisconsin hospital has opened up a Clinical Simulation Center. I was downright giddy when I realized they had an Open House, which lead me to jump in my car and drive down the road see the center for myself.
I have written before about similar Simulation centers and the importance of simulation in healthcare. In fact, I found real inspiration and understanding for Patient Safety due to an eye opening simulation experience. As a Patient Safety advocate and User Experience designer, how can I not be a fan of healthcare simulation?
I'll admit, I felt like a kid in a candy store at the Open House today. UW has built an impressive center for clinical educational opportunities: They have various types of patient simulator mannequins, including infant and pediatric patients, three simulator rooms for OR, ICU, or regular floor clinical situations, control rooms with cameras for observation, and all of the top of the line equipment you would find if it were the real deal. The people I met there were great, and all understood the importance and significance of the center.
The University of Wisconsin Hospital is doing it right. They are investing their money wisely. I've said it before - would a new pilot jump into the cockpit of a 737 and fly 100 plus people without any training? No, they practice on flight simulators in a safe environment. So why wouldn't we expect the clinicians that take care of our family and ourselves to not do the same? I'm glad to see that UW has gotten on board with this trend. I wouldn't be surprised if most large hospital had facilities like this 10 years from now.
Tomorrow's newspaper will probably not be as exciting...
I think the push to move healthcare to become less paper based to more electronic systems is a positive one. I believe it allows clinicians to gather and view data to make quicker clinical decisions. With increased interoperability, the continuity of patient care will improve. And electronic systems can store data in a way to identify different health trends sooner than could be done sorting through paper. All of this helps improve safety and patient outcomes.
But technology cannot be treated as a silver bullet make healthcare safer. This blog post does an nice job of summarize how technology can actually cause harm. The post references an LA Times article from the early summer about an infant that received an accidental overdose of Sodium Chloride. The article goes on to highlight other situations where a patient was harmed due to a technology problem. Dr. Kaushal's quote in the article really caught my attention: "We see problems much more often than we would like because many health information systems are poorly designed and difficult for doctors and nurses to use.”
One thing we need to remember is technology is just part of the healthcare work system. Clinicians do not and cannot work in a vacuum with technology. I have said this a few times, but healthcare technology needs to fit into the system in a way to avoid patient harm. One key is to have well designed and well implemented technology to fit into the system to avoid errors.
This is why I was excited to see the EMR Usability Guidelines floating around this summer. The emphasis on well designed healthcare software continues to grow. Improved usability will not solve all of the Patient Safety problems, but it will be an an important piece of the bigger puzzle for better patient outcomes.
The June issue of Men's Health had a nice article around ways to protect yourself, as a patient, from potential medical errors. The article provides some easy to follow checklists and questions a patient should be asking themselves to help ensure their safety in the hospital. Common patient scenarios like having surgery, requiring an IV, and having a baby are covered with tips for a patient or patient advocate. This is the type of patient education needed to make sure patient's are included in the feedback loop to ensure their own positive outcomes.
What really got my attention as I read the article is where the author went to research his piece. He traveled to the Banner Simulation Medical Center in Arizona to "play doctor" for a couple days to help identify potential opportunities for error in the healthcare setting. As someone who has struggled through medical simulation, I thought it was great idea to support the tips provided in the article.
I applaud Banner for supporting such a large facility for Medical Simulation. The virtual hospital can train up to 1875 nurses in a safe environment to practice for real patients, and is one of the largest of it's type in the world. I feel this is a growing trend that will change the way caregivers are trained in medicine. The best way to sum up the importance of simulation is stated in the Men's Health article: "If they make a mistake, we just reboot the patient." But instead of listing off the benefits again, I would recommend watching this video to hear it directly from the people that are undergoing training there.
If only "rebooting" the patient was just that easy...
I have noticed there has been a lot of articles written around EMR and Health IT usability in the last couple months. This is due to the National Institute of Standards and Technology (NIST) and the Office of the National Coordinator for Health Information Technology (ONC) combining to develop "a set of procedures that are objective and repeatable for evaluating, testing and validating the us... A couple weeks ago NIST held an informational hearing and workshop to present their framework and guidelines for healthcare software usability.
There has been some concern expressed that the guidelines could go too far in standardizing EMRs. Those concerns are understandable. I would not want a governing body creating standards as to what the best designs are to promote usability in healthcare software. Instead, it appears "The goal is to help systems developers and vendors assess and demonstrate that their software is free from design-induced user error. But NIST "will not dictate particular user interface designs.” This article suggests that these guidelines may become "Usability Criteria" for the Stage 2 Meaningful Use regulations, and the NIST is focusing "on EHR usability for the improvement of patient safety." Even HIMSS has been exploring this with an EHR Usability task force, that has been publishing some nice papers on measuring and evaluating usability.
From what I have been reading, this reminds much of the FDA's Human Factors program which requires medical device manufacturer's to show they have followed Human Factors principles. This includes creating requirements that promote patient safety, and testing the devices to ensure they meet those requirements. During audits, the FDA will check to see if a manufacturer include Human Factors as part of the development process.
If this is indeed the case, then this will be a big win for Patient Safety. It has been well documented that poor usability in the healthcare software can lead to errors that can potentially harm patients. With all the distractions and time pressures care givers deal with, technology should be a tool that works for them, not against them. Care givers will have less frustrations in their day to day work, which will allow them to focus more on the patients. A happier, less distracted care giver will make better decisions - leading to better outcomes for the patients. Ultimately, this is what really matters in healthcare.