Kathleen Wessel (Host): Patient safety is top of mind for
providers and healthcare leaders.
Healthcare organizations can fill critical safety gaps and turn compliance
into a competitive advantage by re-imagining safety, quality, and
clinical efficiency through the lens of the patient safety Initiative
and advanced clinical surveillance.
Welcome to a HA Associates Bringing Value, a podcast from
the American Hospital Association.
In this series of podcasts, we speak to a HA associate program, business
partners check in on their efforts and learn how they support a HA
hospital and health system members.
I'm Kathleen Wessel, vice President of Business Management and Operations at
the A HA, and today I'm joined by two esteemed pharmacists, Chris Emerson,
VP of Clinical Quality Training, oversight and Innovation at Innovalon.
And Martha Tran, director of Application Support at Innovalon.
Kristen.
Martha, welcome to the podcast.
Chris Emerson: Thanks.
Really excited to be here today.
Martha Tran: Yeah, thanks so much for having us.
Kathleen Wessel (Host): I wanna jump right in.
I'm excited about this conversation.
We all know EHRs serve as a primary infrastructure for communication and
coordination across healthcare teams, yet they tend to fall short when it
comes to filling critical safety gaps.
Can you share with listeners why the EHR isn't enough when
it comes to preventing harm?
Chris Emerson: Yeah, so I'll jump in first.
Kathleen, I couldn't agree more that the EHR are really just not enough
when it comes to patient safety.
We look no further than a study published in the New England
Journal of Medicine in 2023 by Dr.
David Bateson, colleagues that highlighted that adverse events are
still occurring in nearly one in four admissions with a quarter of those
adverse events being preventable.
And we still have a really long way to go here to get to a state of safe
care for our patient's, uh, in the hospital environment specifically.
In the last six years here, uh, working at Innovalon, which was formerly
called Vigilance, um, I've been heavily focused on the safety event reporting
space, and I think that having a strong culture of safety that really
promotes voluntary event reporting and embraces technology to augment that
voluntary reporting is a cornerstone to an effective safety program.
Through event reporting, data organizations can truly understand
the areas of risks so that they can implement quality improvement
initiatives to address those risks.
And we know from the literature that safety events are dramatically
under-reported with more than 50%, in some cases, all the way up to 80% estimated of
safety and incidents that go unreported.
You know, EHRs are very, very focused on clinician workflows,
documentation related to patient care.
Billing for those services that clinicians are are rendering.
But you know, EHR is also like, they contribute to clinician burnout
through information overload, excessive documentation requirements, cumbersome
system navigation as a few examples, and really also take clinicians away
from being at the bedside, uh, where they provide direct patient care,
which really can also be detrimental to providing safe care for our patient's.
I really also think EHRs are not focused on providing a mechanism
for staff to report safety events near misses and safety concerns
that they come across day to day.
And it's that rich safety event reporting data that can provide organizations
with insights into their areas of risk and drive performance improvement
initiatives to fill critical safety gaps.
The EHR alone can't solve the problems we're facing And we need to be able
to recognize that there are other tools out there that can help identify
and address issues related to safe quality care for our patient's.
Martha Tran: I wanna add onto that a little bit.
Chris touched on just slightly talking about how much data is in the EHR.
So sometimes when talking about EHR is not enough, I almost think it's too much.
There's too much data.
A patient might come into your system with a history of maybe they've been
with you for 10 years, there could be over a hundred thousand data points
in there for the clinician to review.
If the patient comes into maybe critical care, they might be getting 1000 new data
points in just a single day, and that's gonna lead to just a lot of manual work.
A lot of times spent just sifting through that medical record, pertinent
information could get missed, And so you really need something
that can help you make sure that.
You're getting the right data to make the best decisions, And that those
decisions or responses are not delayed.
And so that's where clinical decisions tools can be used.
They're gonna pull key data points together in near real-time, And then
you're gonna have those faster responses.
So the clinical decision tool or alerts, they pull that data in, they
make sure that the data's in the right place at the right time, and
that's what we're looking for and that's what's gonna make a difference.
Kathleen Wessel (Host): It's just an overwhelming amount of information
coming at various clinicians who end up interacting with patient's.
So I appreciate your raising all of those issues.
Before we dive a little further, can you share a bit more about both
your professional journeys And what experiences brought you both to a Neon?
And Chris, why don't we start with you.
Chris Emerson: Yeah, sure.
So, um, as already mentioned, I'm a pharmacist by education.
Uh, I graduated from the University of Michigan, completed a PGY
one pharmacy practice residency at the VA in New York City.
After that, I spent some time as a faculty member at the Arnold and Marie
Schwartz College of Pharmacy and Health Sciences at Long Island University.
And it was really during that time, precepting students out of, uh, Lenox
Hill Hospital in Manhattan, which is now part of Northwell Health.
I became very interested in technology and how technology and healthcare can
improve patient care, and I ended up taking a full-time position at the
hospital there in pharmacy informatics.
Uh, I did that role for about five years before our family relocated to Chicago.
Where I found this job that I'm doing now for the last 12 years, uh, in
healthcare software and supporting and implementing the vigilance pharmacy
surveillance solution for a long time.
But since then, I've taken on a broader role and support all of our
clinical surveillance solutions, our infection prevention, pharmacy
safety and quality products.
Uh, and I have a wonderful team of 17 dedicated healthcare professionals
who support all of our solutions, and Martha is one of them.
And I'll let her, uh, give us her background here as well.
Martha Tran: Thanks, Chris.
So I'm also a clinical pharmacist by training, and I would
say I'm a true Midwest girl.
I went to Purdue University to get my degree, And then I continued
on to La Crosse, Wisconsin, where I was at Gunderson Lutheran for
my pharmacy practice residency.
Then I took on my first job at a large teaching hospital in Chicago.
I started with inpatient oncology.
I would say that's where I got my first taste of how technology
could really improve the patient care and make it safer.
One of the pharmacists I worked with there was really savvy and started
creating templates for us to use for the common chemotherapy regimens and.
These not only calculated or double checked our calculations on doses,
but also made sure the other important pieces of the protocol were there.
So making sure there were pre-meds, or making sure that the patient was
getting the right fluids, all those little things that could easily be
missed if there wasn't a checkpoint.
So then I really started thinking about, You know, technology and kind
of, you know, where I wanted to go.
And I moved on from there to be a clinical manager.
And I started working for an organization that was very, I would
say, forward thinking at the time.
Definitely very data-driven.
They used data And then patient safety to be the things that really set
the roadmap to what they're doing.
So while I was there, I worked closely with clinical informatics
and I was involved in three big technology initiatives.
One was, uh, bedside barcode scanning.
One was implementation of smart pumps, And then finally was the implementation
of a clinical surveillance tool.
So all of these improved patient safety, we caught near misses, wrong
dose, wrong drug, even wrong patient with the bedside barcode scanning.
And then the smartphones really played a major role with helping
those nurses, especially if they're titrating a medication or we had
a nurse led heparin protocol.
It helped ensure the safety of that.
And then of course, where I started with chemotherapy, the administration
of that was also made safer.
But what really stuck with me was the response of the pharmacy
team when I implemented the clinical surveillance tool.
You know, we had a really nice EHR.
They got alerts at order entry.
They had a task list and they got reports for their, their
daily work and prioritizing it.
So when I was tasked with implementing this, I was a little
bit nervous to roll out a new tool.
I had probably, uh, half or maybe a little bit more of our team.
They were the biggest fans of new technology.
And then in particular, I had one pharmacist who just was
adverse to change in general.
So I kind of was really worried about the acceptance.
And I transitioned them over to the tool.
When it first went out, I punched a lot of questions And the questions
kind of slowed a bit, so I kind of thought, oh, maybe they're, they're
really starting to like this.
And then I found out, oh, actually they're still using those paper reports.
So immediately those reports, when the longer printed really had
to kind of force them into using the tool, take away the crutch.
And the pharmacist came up to me and actually thanked me for adding
this tool to their workflow.
So I was shocked.
You know, there was no more manual hunting.
We were getting more work done.
Interventions were definitely getting made sooner.
And one big thing is that important handoffs weren't being missed anymore.
And so my little aha, when the pharmacist came up to me, the one that I mentioned
earlier who was really adverse to change, and she said, you know, you usually just
add more and more work to our plate.
But this has truly helped us with our daily work.
Thank you.
So that was just a great feeling.
I was so excited.
I was really adding a complimentary tool for them, and since I had
spent a lot of time deciding how to do it, it really felt good.
And so that's kind of what got me more interested in this clinical
surveillance, and I ended up leaving that role and moving on to vigilance,
which isn't a Novalon solution.
I've been able to share that tool with so many more pharmacists and I've
been with actually vigilance for 11 years, so I've seen it grow so much.
I'm just as passionate now, 11 years later on improving patient care and
seeing what we can do with the tool.
And I have an amazing team that also share this passion, And we really
just challenge each other every day.
What more could we do?
Kathleen Wessel (Host): I love that both of you, such rich histories that you're
able to bring into your current practice.
Um, and thank you for sharing that story, Martha.
That was wonderful.
Moving on, AJ's Patient safety initiative is a national effort aimed
at improving patient safety across US hospitals and health systems.
Its goals are centered around three foundational pillars,
fostering a culture of safety, addressing disparities in safety.
Enhancing workforce safety.
Can you share with listeners how leading organizations are implementing
advanced clinical surveillance to support the goals of the patient
safety initiative and often turning compliance into a competitive advantage?
Chris?
Chris Emerson: I'll get started with a, a, a little story about a customer
of ours, uh, that's utilizing what we call auto detection here at Innovalon,
And that really is focused around creating that culture of safety.
Specifically, we have a safety event reporting platform that
we call safety management.
And that solution is utilized by several leading healthcare organizations across
the country, and I have the esteem privilege of being able to connect with
those organizations on a regular basis.
And we work very closely with them to identify new and innovative
ways to use the products to improve patient safety and outcomes.
I mentioned this auto detection piece, and that's really one of the most exciting
things that we've worked on here in the last several years and, and I have
a good example of a, of a customer of ours who has a large hospital system,
and they were the first to implement our rules-based AI solution that leverages
a rules engine to automatically detect when safety incidents have occurred
based on data that we're receiving from the electronic health record.
They implemented 21 different, um, rules-based AI scenarios that
they were looking for across, uh, 19 of their hospitals.
And they were focused specifically on medication safety.
And after 18 months they did a comparison of their event reporting
rates, where they compared voluntary reporting to voluntary reporting that
was augmented with auto detection.
So kind of like a before and an after comparison.
And the results were quite staggering.
Uh, they observed a 400% increase in their medication event
reporting rates compared to.
Voluntary reporting alone.
So adding those additional electronic mechanisms to identify when safety
events are happening led to a substantial increase in the number of
events that they had getting reported in that medication event space.
77% of those events that the rules based AI identified were investigated
and categorized as safety incidents.
The remaining 23%, uh, were either closed as duplicate because someone manually
or voluntarily reported that same event or the event was reviewed and deemed
to not actually be a safety event.
So the rules-based AI was, was very effective in being able to identify
actual safety events based on the criteria that we've, we built into those rules.
Since that information was shared at a national conference, uh, we've seen
a significant increase in interest in utilizing this technology to augment
organizations', voluntary event reporting at several other large health systems.
And later this year, to kind of take this to the next level, we're
planning to roll out, uh, a natural language processing model that will
consume documentation from the EHR.
Identify adverse drug events and report those, consume that documentation,
run the model, identify adverse drug events or medication errors,
and report them as safety events in our safety management products.
So really exciting stuff.
The way that we can leverage technology to really support that culture of safety
by increasing event reporting rates.
Taking humans out of the equation, you know, making it so that
individuals don't have to take that initiative to report everything.
Like we can rely on, on technology to do some of this work, And the documentation
is gonna be more accurate, more complete.
All of those things really will help foster a safer environment because
organizations will be able to better understand all of the things that are
going on in that particular area where we're able to leverage this technology.
So one of the parts of my job that I really enjoy the most is
working on this kind of stuff And this technology to really automate
workflows and, and take humans out of the equation for some of these
processes that don't, uh, necessarily get the attention that they need.
And, uh, Martha, I don't know if you have a, maybe you have an example as
well of, of something in this space.
Martha Tran: I wanna touch on the culture of safety.
I think that's one of the best things about the safety initiatives is that
as part of the culture of safety, we're sharing data, we're sharing outcomes,
we're really being transparent, And then that allows us to be able to, you
know, solve problems collaboratively.
We can share best practices before.
It's kind of like that saying, you don't know what you don't know.
So with clinical surveillance tool And the analytics, you can make a change.
Then you can measure the impact, And then you can work on
continued process improvement.
A really good, I would say real-world example of that with one of our clients.
They were looking at the outcomes for bloodstream infections.
This facility, they had a really strong antimicrobial stewardship
team that included specific antimicrobial stewardship pharmacists.
And what they had done is they had pretty recently started utilizing rapid
diagnostic testing, And that just allows for the organism to be identified sooner.
And then when an organism was identified, then it would be the
pharmacist's responsibility to make sure that that patient was on the
right medication to treat the organism.
And so the rapid diagnostic testing was very helpful because they did
get that organism identified sooner.
But where they found a gap was that that information had to get from the lab.
That result had to get to the pharmacist, And so sometimes there was a delay there.
So the institution, what they did is they added real-time alert.
And our clinical surveillance tool was actually able to not just create an
alert in the system, but it actually sent a notification directly to the
pharmacists that were on the team.
And then they were able to, uh, again, match up the correct
treatment for the patient.
And they did show in that study that there was an improvement in the outcomes
of their bloodstream infections.
Kathleen Wessel (Host): Great examples.
Um, I appreciate you both walking through those.
Martha, what is the impact of having real-time surveillance on
pharmacy and medication safety?
Digging in a little more, what are some of the proven strategies in detecting
and preventing medication errors or mis conversions from IV to po.
Martha Tran: I think when we're talking about real-time surveillance,
you're gonna see a really big impact on the outcomes because many times
it's gonna allow your clinician to intervene before an event occurs and
prevent the harm or else very soon so that the harm would be less severe.
So an example with that, real-time surveillance And that type of an impact,
one of the things that pharmacists do on a daily basis is adjust medications
for a patient's renal function.
And so what we did probably when I first started practicing is we had
a report that we manually reviewed.
We usually would review it in the morning and make sure that the
doses for the medications that the patient was on, making sure that were
appropriate for the renal function.
An example where real-time would be much better would be a patient you
might come in and review and their serum creatinine, which is the lab we're
kind of looking at for renal function is one which is fairly normal, so the
pharmacist might just kind of pass over it and continue on with their day.
They've reviewed that patient.
That patient won't get looked at again until the next day.
However, with real-time surveillance, we're able to do trending, and
you're able to see more information, not just that static one value.
And so if the pharmacist had seen, oh, this patient's renal
function or serum creatinine that I was talking about was only 0.5
the day before, oh my gosh, it doubled.
I better take a look and see what's going on with this patient.
So without the whole picture, you are not gonna make the right response,
or that response is definitely gonna be delayed in that example.
Very similarly, another test that pharmacists work on is changing
intravenous medications to the oral route.
There's a few different reasons for doing that around patient safety.
Definitely if they have an IV and it's more of a a risk for an infection.
It might prolong their stay in the hospital.
And then of course there's always cost involved.
And so if the patient can take it orally, typically those
pills would be less expensive.
And it's certainly less expensive to administer because you wouldn't
need a nurse to administer it.
So there's a lot of reasons that pharmacists do focus on
switching over to the oral route.
So sometimes, um, again, this would be an example where you're looking
at that patient in the morning and.
You see, they have a test coming up And so you know they have to
be NPO or they can't take anything by mouth until after that test.
So again, I would review it and be like, check off my list.
I'll take a look at it tomorrow.
But with the real-time surveillance, as soon as that patient gets put on
a regular diet alert can go to the pharmacist, And then they can go
ahead and they can make that change.
This might result in 1, 2, 3, maybe three less doses for
that patient by the IV route.
It might even result in that patient getting discharged a full day sooner.
So really there's a big difference between, um, like monitoring a patient
by a report and manually in comparison to that continuous monitoring That
is always looking 24 7 at that data.
Kathleen Wessel (Host): No, that's great.
Thank you for kind of tying those cause and effect examples together.
I think that's really helpful.
Can you give us some insights into what's working right now with both inpatient and
outpatient settings, and how do members extend safety into outpatient settings?
Chris Emerson: Yeah, so specifically on the safety event reporting side, there's
been a substantial increase in interest from outpatient settings to embrace
electronic event reporting platforms to more efficiently capture, investigate,
track trend, analyze the safety events that are occurring in those care settings.
One outpatient setting in particular we've seen a lot of interest from is
in the ambulatory surgery center space.
In the past couple of years, we've implemented the safety Event
reporting solution in more than 175 ambulatory surgery centers in the us.
So quite a substantial increase.
Um, in, in interest, specifically on on safety event reporting.
What we're finding is that many outpatient areas don't have robust safety event
reporting platforms that can integrate with an EHR or registration system.
Which really helps automate aspects of the event reporting process and and optimize
workflows and investigation processes.
So one of the things that we do is we take that registration information
into our environment, And then when a reporter is reporting a safety
incident, they can use a patient search functionality And that will automatically.
Populate up to like 30 different aspects of a safety event reporting form.
Whereas normally a reporter would have to sit there and type
out all of those data points.
So that's a big barrier to event reporting in general, is that time
commitment to actually sit down and fill out the form and write out the
patient's medical record number and.
Patient ID number and make sure you don't type it wrong, But when you can
integrate with a registration system or an EHR and be able to just execute
a patient search and automatically populate all of that information, and
not only it saves time, but it increases the reliability of the information
that's being put into the form.
Really what we're hearing from the sites, these ambulatory surgery centers who
have gone through this implementation and process with us is that.
Event reporting rates have increased dramatically because of ease of use
of the system, less cumbersome to report the events, and not only that,
they're getting more events reported, so then the administrators of the
system or the, you know, the patient safety managers or quality managers
of these organizations are now able to more effectively understand.
What's going on within their care environments when it comes to patient
safety and they can, you know, identify gaps in care or gaps that need to
be addressed through some process or procedure change, and to help
ultimately improve patient care and prevent future events from occurring.
You know, one recommendation would be if you're in an outpatient, uh,
environment, would be to really assess your current event reporting process
in that area and ensure that your staff have an intuitive, easy to use process
for reporting safety events, And that that system provides the ability for the
administrators to usually track and trend.
Data with reports and analytics, it's always those things you don't know
are going on at your facilities or those near misses that are not getting
reported, that you kind of keep you up at night worrying like, what do
I not know about what's going on?
You know, that could harm a patient tomorrow.
I always think, you know, the more You know, the better chance you
have of being able to do something about it before a patient is harmed.
So.
My big takeaway I think in the last couple of years in working with these outpatient
care environments is they haven't historically had the tools available
to them to really do this effectively.
And, and now there's a big push or an interest in, in getting those tools.
So, You know, take a look at your processes And what solutions you have
available for reporting and evaluate what's out there in the market and, and
see if there's something that's better.
Martha Tran: Yeah, back when I was in the hospital, it was the same thing that we
were pushing for is to get more and more reporting done so that we could really see
what was going on and make a difference.
But I'm gonna take this question just a little different angle here and talk
a little bit about how I think the pharmacists are having the impact.
Both inpatient and outpatient.
And the main setting where I'm seeing That is really through transitions of care.
That's whenever the patient is changing in level of care.
So whenever the patient is admitted and when they're discharged, or it could be
when they come in the critical care unit And then they get switched to a lower
level of care, like a med surg unit.
The example with when the patient is first coming into the hospital,
a lot of pharmacists are involved with medication reconciliation.
So what they're doing is they're looking at the home medication list that the
patient is on And then comparing it to whatever the physician has already
ordered to continue in the hospital, and they wanna make sure that, you
know, medications aren't being missed.
That should be continued, and medications aren't continued.
That should be held.
An example where clinical surveillance tool could really be of use is when
maybe a new medication is being started.
One big topic, uh, right now that a lot of people are interested
in is opioid stewardship.
An example of an alert might be a patient is started on a fentanyl patch,
which is a very long acting medication.
The pharmacist could get alerted because they haven't had anything
on their home medication.
They've had no exposure to an opioid on that home medication list.
So that's a really great example because it's hard to always have the manpower to,
um, take a look and review those lists.
So by adding the clinical surveillance, you'll make sure that really important
things like that aren't missed.
And then as the patient's transition to outpatient, the pharmacists
really need to make sure that the patient's understand their medication.
They need to make sure that their patient's are able
to get their medication.
Beyond just alerts.
Uh, we also have a, what we call a transitions of care list, where we set
rules that run 24 7, just like our alerts in the background to populate the list
so that it can identify the patient's that are gonna benefit the most from the
pharmacists, spending a little extra time educating them, or perhaps we even might
need to get the care management team involved before that patient goes home.
So examples of things that could run in the background might be looking
for social determinants of health.
That's a big one that now there's codes available, so it's easier to capture
that information, but you need to make sure that that patient can afford
that medication when they go home.
If that patient's more worried about getting food, they're not
gonna get their medication filled.
Other types of things, if they're going home on medications that are really more
high-risk of having an adverse event and those patient's, we need to make sure
that they understand what to look for.
So if they're going home on a new anticoagulant, they need to know
the signs of potential bleeding or bruising, and they need to know
what to do when these things occur.
So having that patient well educated is really gonna help not
just their, their patient outcome.
And then also.
It's gonna help the hospital 'cause it's gonna help with
decreasing readmissions as well.
You can see how the tool can monitor both inpatient and outpatient.
And also when you get into the, uh, outpatient setting, alerts could
even be added around follow-up and making sure that the labs that they
need on a regular basis are done.
Because Those are things when the patient leaves the hospital, that
can be really hard to keep track of.
So you can use a tool like this across inpatient and outpatient.
Kathleen Wessel (Host): Perfect examples and really illustrative of kind of
the power of the system when it's set up to help support those goals.
You know, I wanna try to squeeze in one more question at the end, and That is
really, what does the future of patient safety look like for you both, And what
is some practical guidance that you have for a HA members as they look to
implement advanced clinical surveillance?
Chris, why don't we start with you.
Chris Emerson: I'm very optimistic about the future of safety in healthcare.
I mean, we're on the frontier of the AI revolution, and while I certainly
don't think AI's gonna solve all of our problems, I, I think the potential
that AI could have a substantial impact on safety in healthcare is tremendous.
In terms of a practical guidance, I, I guess I would comment specifically
on those organizations that might be thinking about utilizing rules-based
AI or electronic triggers, other technologies really to kind of augment
their voluntary safety event reporting.
So in partnering with organizations on this initiative, I can say that if
you go down this route, that you will undoubtedly have an increase in the
number of events being identified and you may uncover areas, uh, of risk at
your organization that you were never aware of, which is, is really what the
goal of this whole process would be.
You know, you have to use this info new information to build that foundation
of continuous learning and improvement.
And I think that's critical.
If you wanna have a strong culture of safety, you first need to have a culture
of learning, and my suggestion would be to start building the framework
for how these technologies would be utilized and get alignment from the
highest levels of your organization.
Many leaders, they struggle to embrace the idea that having more safety events
being reported as actually a good.
So I think having that culture of learning mentality really needs to be pervasive
throughout an organization for something like this to lead to meaningful change
and improvements And the safety and quality of care that we're providing.
Martha Tran: We're just gonna continue to see increased advances in technology.
We're gonna see it being utilized more, And what it's gonna allow is
for practitioners to really practice more at the top of their scope.
Of course, AI is gonna be the biggest player making changes right now,
but with AI, I think there needs to be a little caution utilized.
I think it's important that everyone understands the
technology that they're using.
And also what the limitations are of that technology.
So clinicians still need to do their own critical thinking and
not rely solely on technology.
It's really meant to be a compliment and not a substitute.
Kathleen Wessel (Host): Yeah.
I love the the comment that you made, Chris around, you know, culture
of safety, culture of learning.
I, I would also add culture of trust that also fits in there as well,
and really instilling the trust from both sides and both roles.
This has been a great conversation and I love kind of the alignment of,
of what you and your organization are doing with members And what a HA
is really focused on, on improving patient safety across the board.
And I wanna thank you both, Chris Martha, so much for joining the podcast and
sharing your takeaways with AHA members.
For our listeners, if you'd like to learn more about the a, a associate program
or anything that you've heard on today's podcast, please visit us at sponsor aha.
And this has been an A Associate Bringing Value Podcast, brought to you
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Thanks for listening.