Raj Ratwani, PhD, director of the MedStar Health National Center for Human Factors in Healthcare and associate professor of the Georgetown University School of Medicine, recently received the American Psychological Association’s (APA) Earl Alluisi Award for Early Career Achievement. The award recognizes outstanding research and other achievements made by psychologists within 10 years of receiving their PhD.
Dr. Ratwani’s contributions to the field include advancing electronic health record (EHR) usability research and policy recommendations, laying the foundation for solutions to prevent or mitigate interruptions and task resumption challenges in health care, and leading the Center’s growth and visibility on regional, national, and international levels. The Center is part of the MedStar Institute for Innovation and works in partnership with MedStar Health Research Institute and others throughout MedStar Health.
The collaborative team will use innovative machine learning algorithms to quickly identify areas where improvements can be applied to shape the future of safe and effective patient care. Pennsylvania is the only state in the U.S. that requires healthcare facilities to report events that could potentially cause harm to patients, as well as events that have been shown to cause harm. The MedStar Health Human Factors Center is uniquely positioned for this work given its experience at the intersection of research, innovation, and action to inform patient care.
Two educators at MedStar Simulation Training & Education Lab (SiTEL) have received faculty grants from Georgetown University Medical Center (GUMC) for the educational initiatives they designed for students.
Both John Yosaitis, MD, MedStar SiTEL’s medical director, and Alex Walker, PhD, senior director of learning research and design, were among this year’s recipients of GUMC’s CIRCLE Grant. The grant is awarded to faculty pursuing innovative educational initiatives for the benefit of medical students and the institution.
Yosaitis collaborated with students and an interdisciplinary group of faculty to make diverse, peer-to-peer and self-directed experiential learning opportunities accessible to students at Georgetown University School of Medicine (GUSOM) around the clock. In addition to his role at MedStar SiTEL, Yosaitis is director of the Integrated Learning Center and assistant professor at Georgetown University Medical Center.
In a separate effort, Walker and other collaborators will use the award to develop a pre-matriculation workshop for students that explores strategies for learning in medical school, as well as how to become self-regulated, confident learners. Walker is an assistant professor of emergency medicine at Georgetown University Medical Center.
Why—and how—did a diverse group of MedStar Health Emergency Department (ED) associates (innovatively) share more than 50 ideas that could improve the ED experience across our system—regardless of their job in the department?
This March, the 2019 MedStar Health Emergency Department Innovation Challenge invited MedStar associates whose main job responsibilities focus on the ED—including nurses, physicians, advanced practice clinicians, techs, security, social workers, and any others—to submit ideas individually or in teams of up to five people that could change their ED shift. MedStar Emergency Physicians co-sponsored the Challenge with MedStar Institute for Innovation, MedStar Risk Management, and MedStar Nursing, offering two great prizes to both winning teams: MedStar exploring the ideas and tickets to a sporting event. Entries were submitted online and summarized the problem the idea addressed; the solution and its implementation; the value proposition of the innovation; metrics for measuring success; why the idea (like any idea!) might not work; and the people entering.
Selecting the Winning Ideas
Both peers and judges ultimately helped identify the two winners via a multi-part process. First, the Challenge Steering Committee identified 25 semifinalists from the 52 submissions for inclusion in a peer voting process. Next, from April 3 through April 10, ED colleagues could each cast up to 10 votes for ideas with the greatest potential via an online survey, logging nearly 1,500 votes overall to identify the eight finalists detailed below, along with event pictures.
On April 25, seven crowd-sourced finalists each presented a 4-minute pitch, either in-person or via recorded video, followed by a 4-minute Q&A, to a panel of judges and other attendees at the MedStar Innovation and Design (MIND) Lab located off the main lobby of MedStar’s corporate headquarters in Columbia, MD. The judges who selected the winners after a closed-door discussion included MedStar leaders Jonathan Davis, Susie O’Mara, Chris Richter, Larry Smith, and Mark Smith.
The winners included:
It’s 2019, and we read a MRN on the phone to admit a patient? A hospitalist communication system for admissions
Carolyn Phillips and Michael Yacovelli MedStar Washington Hospital Center and MedStar Georgetown University Hospital emergency medicine resident and attending physician team
Less PercoceT and more PT: The MedStar Health Urgent Physical Therapy Program
Munish Goyal, John Brickley, Lindsay Batson, and Liz Delasobera MedStar National Rehabilitation Hospital, MedStar Washington Hospital Center, MedStar Georgetown University Hospital, and MedStar PromptCare physician and physical therapist team
The Challenge Steering Committee stressed that they may also further explore other finalist ideas, in addition to summarizing the themes from all submissions for leadership review.
Igniting Innovation Energy at MedStar
The timing of the Challenge also marked the one-year anniversary of the MIND Lab, an innovative space for all MedStar associates and visitors to see, think, and work differently. The MIND Lab is a venue for creativity, collaboration, and curiosity—all qualities that made the first MedStar Health Emergency Department Innovation Challenge a success.
Stay tuned for information about future Innovation Challenge opportunities and outcomes, and congratulations to all participants.
CHALLENGE FINALISTS Note: Named in the order pictured, from left to right, if applicable. Those who are not pictured have an asterisk next to their name.
The website, which was launched in collaboration with the American Medical Association, makes videos from the clinician’s point of view available for the first time to demonstrate the risks and challenges caused by poor EHR usability, which is the extent to which the technology can be used efficiently, effectively, and satisfactorily. The site also specifically calls out what multiple stakeholders—policymakers, healthcare providers, EHR vendors, and patients—can do.
The theme of the website and campaign is ‘Everybody Has Responsibilities’ to stress the need for increased collaboration. As a shared opportunity for action, stakeholders can sign the MedStar Human Factors Center’s letter to elected leaders of the United States Senate and House committees that can prioritize EHR usability and safety in their oversight of new policies being put in place by the Department of Health and Human Services. Click here to sign the letter to Congress by Feb. 28, 2019, the month that marks the 10-year anniversary of the federal act that successfully promoted the widespread adoption of EHRs.
The opinion piece examines how gag clauses in EHR vendor and healthcare provider contracts block providers from openly addressing EHR usability and safety issues, representing “a market failure.” Despite the 21st Century Cures Act inviting action to help prevent this in 2016, the Office of the National Coordinator (ONC) of Health Information Technology has yet to define what constitutes blocking EHR usability and safety information. The article discusses three main criteria the ONC should consider in doing so and why it’s critical to act on this now.
It reported that electronic health records (EHRs) may present a significant risk to the health and safety of children. Of 9,000 analyzed pediatric reports more than one third described a medication error that was related to EHR usability. The findings emerged from the analysis of pediatric patient safety event reports that were likely to be related to EHRs and medication, gathered from three healthcare systems.
Raj Ratwani, PhD, director of MedStar’s Human Factors Center and a lead researcher and author, also discussed the study further on Nov. 6 as part of a Health Affairs briefing on its full “Patient Safety” issue, where numerous article authors commented on the best and latest research on this topic.Click here to read more and watch the recorded webcast.
MedStar Health and Pew Charitable Trusts Respond to Congressional Act
September 10, 2018
Washington, D.C. (September 10, 2018)—Experts with MedStar Health’s National Center for Human Factors in Healthcare have leveraged their past research into the safety and usability of electronic health records (EHRs) to join with The Pew Charitable Trusts in offering recommendations to the federal government for making the health IT systems safer for children, whose unique needs make them particularly vulnerable to documented EHR usability and patient safety issues. The recommendations were published today by the American Medical Association in its journal JAMA Pediatrics, in a Viewpoint article entitled “Improving Pediatric Electronic Health Record Usability and Safety through Certification.”
The authors are Raj M. Ratwani, PhD, with National Center for Human Factors in Healthcare, and Ben Moscovitch, MA, and Josh P. Rising, MD, with The Pew Charitable Trusts.
Their recommendations are in response to a provision in the 21st Century Cures Act, passed by Congress in 2016, for the Office of the National Coordinator to develop a voluntary program that would certify EHRs in a way that accounts for unique issues in pediatric care.
“Children have unique healthcare needs, and oftentimes care processes that may work well for adults do not work for children,” says Dr. Ratwani. “While we have recognized the unique needs of children when it comes to things like medications, we have not recognized this need when it comes to technology like the electronic health record.” EHRs, which are almost universally used across the United States to manage patient care, are not tailored to the unique needs of children or clinicians who treat them, and this can put pediatric patients at risk.
The authors cite a couple of instances where the poor usability of EHRs has contributed to potential harm:
Medication dosages for children are based on weight, and poor EHR usability has contributed to overdoses being given when a confusing EHR display makes it difficult to enter a child’s correct weight.
Age-appropriate vaccinations may be overlooked due to the EHR’s failure to notify the clinician of a needed vaccine or the wrong vaccination may be given when the EHR recommends a vaccine that is inappropriate given the child’s age.
The authors provide these five recommendations for a certification program:
Require EHR vendors to provide evidence that they are employing a user-centered design process.
Require that usability test participants represent the clinical end users.
Define and require the use of rigorous test cases to assess usability and safety.
Recognize that EHR implementation is crucial to safety, and consider the entire EHR life-cycle—not just the development phase—when granting certification.
Encourage transparency in sharing usability and safety challenges to improve safety and EHR product.
About the National Center for Human Factors in Healthcare
The National Center for Human Factors in Healthcare occupies a unique position in the United States as the largest human factors program embedded within a healthcare system. It brings together human factors scientists, systems safety engineers, health services researchers, and clinicians to conduct safety science and applied research in medicine to improve safety, quality, efficiency, and reliability. The center is part of the MedStar Institute for Innovation and is affiliated also with the MedStar Health Research Institute. MedStar Health, the parent organization, is the largest not-for-profit healthcare provider in the Maryland and Washington, D.C., region, with 10 hospitals and an extensive ambulatory services network, and is the medical education and clinical partner of Georgetown University.
Recommendations on how to advance usability and safety throughout the EHR software life cycle, which can be used as the foundation for a voluntary certification process for developers and EHR implementers.
Criteria detailing what constitutes a rigorous safety test case and the creation of sample test case scenarios based on reported EHR safety challenges.
Read the report titled “Ways to Improve Electronic Health Record Safety” for more on our voluntary certification process recommendations, rigorous test case criteria and example scenarios.
MedStar Simulation Training & Education Lab’s (SiTEL) expanded Baltimore simulation center is bigger and more realistic than ever, giving clinical and non-clinical associates hands-on training without risking patient safety.
“What we’re attempting to do is make a safer medical environment,” said John Yosaitis, MD, medical director at MedStar SiTEL.
The lab isn’t just for doctors and nurses. Everyone who has a role in caring for a patient, even those who clean the rooms, will have a chance to train throughout their careers. Training areas are built to mimic areas of the hospital and can be equipped to support future training modalities such as virtual reality.