First Emergency Department Innovation Challenge Successfully Hosted Across MedStar Health

Challenge Steering Committee members Ken Canonge (left), Kathryn Burroughs (center), and Kevin Maloy (right) leading the event.
Challenge Steering Committee members Ken Canonge (left), Kathryn Burroughs (center), and Kevin Maloy (right) leading the event.

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

Challenge judge Jonathan Davis announcing the winners.
Challenge judge Jonathan Davis announcing the winners.

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

Challenge finalist Elizabeth Marx (left) connecting with Challenge judge Mark Smith (right), among others networking.
Challenge finalist Elizabeth Marx (left) connecting with Challenge judge Mark Smith (right), among others networking.

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.

WINNERS

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
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

OTHER FINALISTS

Whose vein is it anyway? Piloting existing technology to stop sticking patients repeatedly for blood
Debbie Heckler and Elizabeth Marx
MedStar Union Memorial Hospital nurse team
Modernizing the waiting room: Improving the waiting experience with text messages and videos
Jennifer Thompson*, De Anndra Charles, Manpreet Saran*, and Carren Heinser*
MedStar Washington Hospital Center physician, nurse, and patient advocacy team
Does PPID really have to be this hard? Putting a monitor with a scanner and printer in every ED room
Rachel Thornton*, Beth Luther*, and Victoria Mestre*
MedStar Washington Hospital Center nurse team
Is this an airport or an ED? Patient kiosk check-in for the ED waiting room
Rahul Bhat and Tamara Katy
MedStar Georgetown University Hospital and MedStar Washington Hospital Center physician team
Your advanced directive is ... somewhere in the computer: Making MOLSTs easier to find in the EHR
Kelly Schutz, Sarah Marrone, and Kevin Scruggs*
MedStar Good Samaritan Hospital
Excuse me but ----- : Decreasing interruptions with EHR integrated non-critical communication technology
Rahul Bhat
MedStar Georgetown University Hospital and MedStar Washington Hospital Center physician

MedStar Human Factors Center Launches EHRSeeWhatWeMean.org and Encourages Action

On Feb. 4, 2019, the MedStar Health National Center for Human Factors in Healthcare launched EHRSeeWhatWeMean.org and a related campaign, presenting compelling evidence for the need to address the known risks to patient safety and clinician burnout that stem from poor electronic health record (EHR) usability—and calling for action.

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.

For a deep dive into the research and thought leadership informing that letter, read the Journal of the American Medical Association Viewpoint, “A Decade of Health Information Technology Usability Challenges and the Path Forward,” which was written by Raj Ratwani, PhD, who leads MedStar’s Human Factors Center, and two co-authors, all of whom serve as top EHR usability and safety experts.

Learn more about the videos and campaign in MedStar’s press release: “Experts Call for Safety Improvements as Widespread EHR Adoption Reaches 10 Year Milestone.”

Media Contact

Marianne Worley
[email protected]
410-772-6661

Journal of the American Medical Association: Improving Electronic Health Record Usability and Safety Requires Transparency

Ratwani-Health-Affairs

On Nov. 29, 2018, the Journal of the American Medical Association published a viewpoint article titled, “Improving Electronic Health Record Usability and Safety Requires Transparency,” by authors from MedStar Health’s National Center for Human Factors in Healthcare, American Medical Association, and Brigham and Women’s Hospital.

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.

Learn more about the background and policy recommendations tied to this issue in MedStar’s related press release: “3 Policy Changes That Could Make Electronic Health Record Systems Safer and Easier to Use.”

Photo Credit: Health Affairs.

Media Contact

Marianne Worley 
[email protected]
410-772-6661

Health Affairs: Identifying Electronic Health Record Usability And Safety Challenges In Pediatric Settings

Ratwani-Health-Affairs-2

On Nov. 5, 2018, the health policy journal Health Affairs published an article by MedStar Health’s National Center for Human Factors in Healthcare and its collaborators titled, “Identifying Electronic Health Record Usability and Safety Challenges in Pediatric Settings.”

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.

Learn more about the findings, related stakeholders, and calls to action in MedStar’s press release: “Additional Safety Measures Recommended After Study Finds EHR Usability Issues Pose Risk to Children.”

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.

Photo credit: Health Affairs.

Media Contact

Marianne Worley
[email protected]
410-772-6661

5 Recommendations to Make EHRs Safer for Pediatric Patients

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.

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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.

Media Contact

Marianne Worley
[email protected]
410-772-6661

Texas A&M School of Public Health: Miller Awarded 1.4 million to Develop Sepsis Alert System

Kristen Miller
Kristen Miller, DrPH, CPPS

Kristen Miller, DrPH, CPPS, Senior Research Scientist at the National Center for Human Factors in Healthcare at MedStar Health, was featured in a Texas A&M School of Public Health Spring 2017 alumni spotlight. She was recognized for being awarded a 4-year, $1.4 million R01 research grant from the U.S. National Library of Medicine through the U.S. National Institutes of Health to develop a new approach to detect and treat sepsis—which nationally infects about 1 million people annually, killing a quarter of them.

Miller will lead this work from MedStar, marking a significant milestone for the MedStar Institute for Innovation (MI2) and its National Center for Human Factors in Healthcare, as the NIH R01 research grant is among the most prestigious awards. This is the third R01 grant awarded to an MI2 associate.

Read more.