Empowering Patient Human process

Walid Elias Kai
Universite Paris Dauphine , France

Advances in medical device technologies continue to provide opportunities for better healthcare, and fields such as genomics will offer tremendous potential over the coming years. There has been an acceleration of new knowledge, new drugs, and new opportunities. Information technology continues to undergo radical transformations in the evolution from the room-sized calculators of the 1940s to portable, all-purpose devices supporting communication, calculation, and a wide range of human activities. Capabilities now exist to capture and support various forms of information and communication that were previously either impossible or too inconvenient to be practical. Over the next five years, we will see tremendous advances in the form and content of human-computer interaction. New devices and connectivity options will drive the era of pervasive computing, in which people can access information services from the home, office, automobile, and other locations. A focus on human-centric processes is necessary for healthcare organizations to realize the full benefits of information technology advances. The goal of information technology in healthcare is to provide simplified, convenient access to meaningful information for human beings as they communicate and collaborate in the course of providing care. The current rate of technology change, however, often leads to an excess of complex devices and complicated information that provides more cognitive burdens than it relieves. The challenge for information technology in healthcare is to provide processes and techniques to contain the rate of change and variability and thus reduce or eliminate the barriers to effective use of information technology in improving quality and patient safety.

Objectives: A focus on human-centric processes is necessary for healthcare organizations to realize the full benefits of information technology advances. The goal of information technology in healthcare is to provide simplified, convenient access to meaningful information for human beings as they communicate and collaborate in the course of providing care. The current rate of technology change, however, often leads to an excess of complex devices and complicated information that provides more cognitive burdens than it relieves. The challenge for information technology in healthcare is to provide processes and techniques to contain the rate of change and variability and thus reduce or eliminate the barriers to effective use of information technology in improving quality and patient safety.

Study design: Human-Centric Processes Human beings are dynamic and unpredictable, with imperfect memories. We frequently misunderstand symbols, words, and expressions and have insufficient knowledge of new or unfamiliar domains. Advances in technology often lead to excesses of information that tax the human information processing system beyond that which is necessary to accomplish the task at hand. Thus, it is imperative that systems be designed from a perspective that optimizes human strengths and accommodates weaknesses. Three increasingly specific areas that focus on the human element in man-machine systems include human factors, human-computer interaction, and computer-supported collaborative work.

Methods: Nielsens Usability Heuristics Nielsen13 lists a number of design heuristics for the user interface, as shown in Table 8-1. The emphasis on human-computer interaction and usability testing will increase as software supports a greater number of tasks that were previously performed manually. For example, electronic ordering systems should present all the information necessary for a clinician to make the correct decision clearly. Usability testing and evaluation techniques are necessary to measure how well a software system meets these requirements.

Results: Automated hardware and software can benefit the medication use process by helping to reduce errors associated with common causes of medication errors pointed out by Cohen.21 For example, failed communication can be assisted with electronic transmission of orders that have been subjected to validation; drug distribution can be enhanced by using the unit-dose system with bar-coded information, along with proper use of automated dispensing equipment. Typical elements of automation currently in practice include the following: Automated ordering, with validation and screening against drug interactions Physician access to patient and clinical information Bar-coded medication Automated dispensing Automated delivery Automated bedside scanning systems Alerts and other collaborative tools in the event of an error Patient access to information

Conclusions: Healthcare organizations that focus only on point solutions will introduce additional errors either from automating faulty processes or from failures associated with technology. Leaders of healthcare organizations should focus on system-wide processes and implement technologies appropriately. By focusing on the human element in the system, the full benefits of information technology can be realized and errors can be avoided. 1. Implement a system-wide approach to preventing, avoiding, detecting, and recovering from errors. The first step is to understand that complex systems result in errors caused by fragmented processes and organizations. Many of the barriers to error reduction are cultural or psychological. Individuals operating within a punitive environment are often reluctant to admit an error was made. In other cases, the lack of a system-wide approach fails to yield enough information to understand the true cause of an error. Dealing with complexity is something that requires human intervention. In health care, we focus on individual carefulness and expect that to prevent errors, said speaker Martin J. Hatlie, a lawyer and president of Chicago-based Partnership for Patient Safety.9 The bigger and more complex you make it, the more places there are for it to break down. Medical errors are often the result of complex interactions of individuals performing their jobs correctly. The root-cause analysis attempts to address the complexity of a system to uncover the cause, not just the obvious subsequent consequences of the cause. It recognizes that human activities are error prone and includes the human factor in the analysis.22 Implementing such a process may require reorganizing or repurposing current staff and requires collaboration among staff and administration to ensure a nonpunitive culture that learns from errors. At the Luther-Midelfort Hospital, initial investigations revealed approximately 200 to 230 potential medication errors for every 100 charts.23 Improvement came with an organizational change featuring strong leadership and a focus on individual processes, including admissions, transfers, and discharges.