How Health Care Leaders Can Optimize IT Systems to Improve Clinical Quality and Patient Safety

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Health systems around the world are investing billions of dollars in clinical information technology (IT) systems, such as electronic health records, in the hopes of improving their productivity and outcomes. However, more evidence is needed to confirm if and how these systems produce the desired results, according to Johanna Westbrook, PhD, MHA, the Elizabeth Blackburn Investigator Leadership Fellow at the National Health and Medical Research Council and the co-director of Harvard Medical School’s Safety, Quality, Informatics, and Leadership program.

Westbrook notes that if organizations do not fully understand the benefits of clinical IT systems, they may not be using them to their advantage. Medical professionals and clinical leaders responsible for improving quality and patient safety profiles can help address this knowledge gap by learning how to optimize the organization’s informatics systems in a value-added way.

Realizing the Full Potential of Clinical IT Systems

Westbrook and her colleagues focus their research on exploring how organizations can use clinical IT interventions to their full advantage, with the ultimate goals of reducing errors, improving outcomes, and providing the safest level of care.

“My work has involved large-scale studies to measure the effects of medication-related technology in reducing medication errors, as well as looking at how these systems impact the work of clinicians and the new types of errors created when these systems are used,” she explains. 

How to Use Health Care IT Systems Effectively: Three Lessons Learned

Over the course of her research, Westbrook has found some common themes that can help medical professionals and health care leaders advance their efforts to improve clinical quality and patient safety. Here are three of her top lessons learned about managing informatics effectively:

Lesson #1: It’s critical to ensure that IT programs, such as electronic health records, are designed in a safe and effective way to minimize adding new errors to the system.

“Our research goes to the heart of this, applying rigorous approaches to assess how clinical information systems can contribute to improvements in clinical outcomes and generate evidence to identify how we can optimize these systems,” Westbrook says. For instance, one of her recent studies involves conducting a randomized controlled trial to assess whether the introduction of electronic prescribing and medication administration systems can reduce medication errors in children.

She discovered that while technology systems may improve safety over the long term, implementing such systems can initially increase safety risks and add new errors into the equation. 

“This study showed that in the short term [following the introduction of such a system], there was an increase in prescribing errors. One year later, there was an overall decrease in these prescribing errors. Still, we identified a range of new types of medication errors that did not occur with paper-based medication records,” Westbrook says. She points out that such technology-related medication errors can be related to the design and use of the system. 

“Some examples include prescribers who accidentally select an incorrect option from a drop-down menu, a failure to change default settings for an order, or a duplicate order that may have occurred as a result of not refreshing a screen. These types of technology-related medical errors have been identified in systems used worldwide,” she stresses.

What this means for health care leaders: It’s essential to develop systematic ways of monitoring the outcomes of IT systems to identify any issues and to be prepared to address design flaws and workflow issues to mitigate these errors. This is equally important for organizations transitioning from one IT system to another.

Lesson #2: Implementing new IT efforts alone is not enough. To achieve optimal results, organizations need to go beyond technology to support the people who will be using the system.

“People often think that informatics is all about the technology, but many clinical IT systems are complex, large-scale interventions that are being implemented in diverse health settings, thus requiring significant changes in practice for multiple care providers,” Westbrook says.

“Our research focuses on how such technologies are used in real-world situations, where clinicians may be fatigued, time pressured, or resource constrained and are dealing with dynamic work demands. We investigate how these many factors may impact the ways in which technology can support or hinder the safety and effectiveness of their work and, therefore, how systems can be better designed for different contexts,” she says.

Westbrook notes that investigating the human-technology interface must be an important element in designing systems that enhance people’s work efficiency and effectiveness. 

“Multiple techniques are available to examine this phenomenon and the evidence generated can assist in identifying ways in which technology both hinders and improves work performance. Understanding the impact of health technologies requires a fundamental understanding of the health system landscape and the contexts in which care is delivered to patients,” she adds.

What this means for health care leaders: It’s necessary to ensure that the design and implementation of any IT systems are optimized for real-world scenarios and users must understand the goals and know how to achieve them using the system’s features.

Lesson #3: Just because new IT capabilities come to market doesn’t mean they should be adopted; rather, they should be developed as part of a broader strategy to innovate more effective work processes while improving safety, quality, and outcomes.  

With the increasing focus in most health systems on quality and safety metrics, it’s critical to remember that using the wrong technology can hinder—not help—some processes.

“Converting a paper form into an electronic form can reduce work flexibility and take more time; requiring staff to log on with passwords to provide signatures can reduce work efficiency. Thus, the introduction of new clinical information systems should focus on how technology enables work to be undertaken in different ways that improve workflows and outcomes from patients and health care providers,” Westbrook says.

What this means for health care leaders: It can be helpful to start with a problem and then find the best technology to address the situation, rather than trying to make any one solution work for multiple situations.

Looking to the Future of Clinical IT Systems

As technology continues to advance, health care providers in leadership roles must stay up to date on evolving generative AI capabilities, increasingly sophisticated electronic decision support, and other groundbreaking initiatives. That way, they can be prepared to help their organizations find the best options and determine how best to adopt them.

“For instance, while AI is creating new opportunities, there are also risks and potential biases that can be embedded in these systems, which can produce unanticipated consequences. In addition, understanding how electronic decision support can be used to deliver improved outcomes is becoming increasingly complex. Leaders need to be alert to the potential challenges that these new technologies may present and understand the best approaches for monitoring and mitigating such risks,” Westbrook stresses.

The good news is that when leaders engage closely with IT system users, substantial safety and workflow benefits can be achieved. It is important to evaluate both the anticipated and unanticipated effects of IT systems and then respond to those findings. Leaders must also continue to challenge IT vendors to provide evidence that their system features can improve safety and workflows in different contexts. This ensures that the best IT systems are in place—and that quality and safety are at the forefront of their efforts.

  • Sources

    Westbrook, Johanna, PhD, MHA, NHMRC Elizabeth Blackburn Investigator Leadership Fellow; Co-Director of Harvard Medical School’s Safety, Quality, Informatics, & Leadership Program, email interview December 2023.

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