At the intersection of health IT and patient safety: 6 Qs with University Hospitals' CMIO Dr. Jeffrey Sunshine

The landmark publication of the Institute of Medicine's 1999 report To Err is Human: Building a Safer Health System helped spur the digitization of healthcare for the purpose of making patient care safer. While significant progress has been made, the journey to zero harm is far from finished.

Recently, Becker's caught up with Jeffrey Sunshine, MD, PhD, the chief medical informatics officer for University Hospitals in Cleveland. Dr. Sunshine offered insight into EHR usability, the keys to successful vendor partnerships, and where he's seen health IT have the greatest impact on patient safety.

Question: What are the keys to a successful vendor partnership, and how has your organization's partnership with Allscripts evolved?

Dr. Jeffery Sunshine: As with any relationship there is an ebb and flow where conversations and effort move along the continuum of short through long-term needs. As implementations have finished or wind down, local knowledge of Allscripts tools has maximized. The attention then shifts to longer-term needs and themes such as how to continue the shift into value-based care and management of individuals as members of a broader population.

Q: How important is it to have clinical leaders on executive teams? What do clinicians bring to the table as decision makers? 

JS: Clinical leaders on executive teams assist bringing forward the frontline needs of active clinicians as they work to deliver excellent care under high efficiencies. Clinicians bring seasoned experience in making critical impactful decisions even when we face incomplete data or less than full knowledge on a patient or their disease. They have typically already learned to manage competing priorities.

Q: Is healthcare approaching a place where EHR usability will no longer be a patient safety issue? 

JS: This question is a bit of a mixed metaphor as usability and safety aren't equal. For example, one could face a highly useable system that isn't safe. That said, facing a poorly useable system impedes a clinician from finding, sharing or acting on key information or correctly selecting highest priority activities. Healthcare IT has moved to more consistently address usability which at least helps unburden the active clinician so their attention returns to care. This movement took a long time to ascend to the attention of many and has not yet reached an optimum in my opinion.

Q: Where have you seen health IT have the greatest impact on improving patient safety at your organization? 

JS: Here as with most places we shouldn't overlook that health IT has solved a dominant problem of often missing clinical information at the time and location of care that had been normative in our preceding paper world. Patients arrived for care in an emergency department or hospital, yet all their outpatient care was secluded in each provider's office paper charts. Secondly, we had faced a common issue of difficult legibility, which has also resolved. Third, though likely subject to too many alerts, at its core health IT allows us to alert and prevent misadministration of medications when contraindicated either by known allergy or in known problematic combinations. Many new issues have arisen, yet those previously predominant safety issues have cleared. Beyond this we have moved into providing consistent best practice of care while having enabled measurement of the reproducibility of that care. For example, in sepsis care, through order sets and care plans, we now more assuredly get the correct care delivered sooner, which here at University Hospitals has reduced mortality resulting in hundreds of saved lives. 

Q: How can genomic medicine advance patient safety initiatives now and in the future? 

JS: Genomic information represents our newest clinically relevant data, and we continue to learn new applications for safer care. A more prevalent example of this occurs as we align best chemo and other cancer therapies based upon the specific genes of the patient and even the tumor itself. For one circumstance a chemotherapy has good outcomes despite risks, for another set of genetic background that therapy provides risk but little chance of benefit — we now know to pass on that option. We expect these data to continue to spread in influence to impact which medication among choices to use for domains such as psychiatry, errors of metabolism or preventive reduction of known risk factors in chronic diseases.

Q: What professional achievement in the last five years are you most proud of? 

JS: The last five years has required great dedication to the implementation of electronic records and other clinical systems in ever growing uniform alignment across wide domains of patient care. Once in place and unified, these have allowed us to speed our responses to improve care rapidly across whole populations. The most apparent recent example has been our response to the opioid epidemic here, regionally and nationally. In less than a year, we have been able to analyze trends, develop controls for use in real time, and specifically track outliers that combined permitted rapid response and improved behaviors all under the pressures of a rising epidemic. We simply couldn't have responded that well, that quickly, nor that widely without the system structures in place through all our efforts.

For more insights on healthcare's patient safety journey, check out this new e-book  from Allscripts.

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