Promoting Patient Safety with Web-based Patient Profiles

Elderly patients with chronic health conditions typically receive treatment across multiple settings and may be vulnerable to resultant medical errors and poor quality of care. Nursing home patients are particularly vulnerable because they generally require a higher level of care and are frailer than their community dwelling counterparts. Typically, they see numerous providers, take more medications, and are more likely to be hospitalized. In addition, they may be less likely to provide an accurate medical history due to functional or cognitive impairment, increasing the potential for harm.

This project examined the feasibility of developing an electronic health information network to provide clinicians access to a patient’s medical history and health status during transfers between residential long-term care (LTC) and acute care treatment environments. The ability to exchange relevant medical data in real time is crucial for all members of the care team, including primary care providers, specialists, pharmacists, home health aides, patients, and caregivers. Better management of health information is central to achieving patient safety.

The specific aims of the project were as follows:

• Specify the clinical and organizational needs that can be met through the use of health information technology (IT). 
• Assess the feasibility of health IT implementation and develop an implementation plan. 
• Specify procedures for ongoing project evaluation. 

Researchers conducted interviews with a variety of stakeholders from LTC facilities, emergency and non-emergency transport, hospital emergency, and acute care treatment facilities. They also conducted a modified Failure Mode and Effect Analysis (FMEA) on current transitions process flows to identify potential failures modes, possible risks, and actions to mitigate failures. Stakeholder workgroups were convened to identify a potential network model to support electronic health information exchange. It was noted that the ability to disseminate patient-specific information across multiple care delivery systems was challenging. In LTC settings, electronic health records (EHRs) are not routinely used, are typically not interoperable with other EHRs, and are costly to purchase or upgrade to become interoperable systems.

Despite barriers, the team reached consensus that a centralized network model provided the capability to meet data and functionality requirements, while allowing nursing home physicians the opportunity to retrieve needed information. Investigators were able to develop an EHR user agreement as an interim solution, allowing credentialed physicians practicing in LTC facilities electronic access to hospital based health records for their LTC patients.