Early adopter hospitals have demonstrated dramatic gains in safety by monitoring patients' electronic health records (EHRs) in real time for signals of potential safety events, allowing providers to more quickly and effectively address safety gaps and improve outcomes.

Developed by patient safety experts, automated safety surveillance software continuously runs in the background of EHR systems and can detect hundreds of categories of adverse events as they occur. Expert analysis then quickly helps organizations gain insight from the data, which can be used to proactively reduce safety risks and reliably measure incidence of harm over time.

As one of several initial action steps to implement the Roadmap to Health Care Safety for Massachusetts, the Betsy Lehman Center is laying the groundwork for a voluntary pilot initiative to enable EHR safety surveillance in six-to-eight Massachusetts hospitals, allowing each to improve its knowledge about the extent of patient harm and save lives. The pilot will yield essential information on how well this approach:

• Provides a diverse cohort of acute care hospitals with actionable data on a broad range of safety events.
• Results in overall reductions in patient harm and associated costs.
• Promotes a culture of safety and workforce well-being without overburdening hospital operations.
• Offers state health care agencies and policymakers useful data on statewide safety risks and trends.

The pilot program’s goals are also well-aligned with new recommendations from the President’s Council of Advisors on Science and Technology, issued this month, that call for more effective, frequent and transparent reporting on patient harm, including the use of analytics from real-time EHR data.

Clinicians quickly use new data to improve care

A group of Massachusetts health care leaders working with the Betsy Lehman Center on approaches to improving safety measurement and transparency recently attended a presentation by Barbara Pelletreau, R.N., M.P.H., who described the implementation of automated EHR surveillance at Dignity Health, where she served for more than 20 years before retiring earlier this year as Senior Vice President of Patient Safety for CommonSpirit Health. Dignity Health was a 40-hospital system operating in California, Nevada and Arizona before it merged with Catholic Health Initiatives to form CommonSpirit Health in 2019.

Pelletreau says that using an electronic trigger system to improve patient safety “was a game-changer for Dignity hospitals.” Automated surveillance of current patient records provides continuous data while it alleviates much of the burden of reporting safety events, which is a largely manual process. The hospitals recently presented data showing that in a 16-month period the new system found more than 10 times the number of serious harm events than their legacy reporting approaches. And patient harm was reduced across the system by 26% in one year.

With strong leadership engagement, good technical support and careful planning and training, Pelletreau and her team were able to address questions and the natural skepticism that arose among some clinicians and staff members as the system was introduced at each hospital. Pelletreau says the immediacy of the data and analysis quickly engages clinicians who are eager for ways to improve patient care.

For example, she notes, soon after the automated system was implemented, triggers indicated that a hospital’s intensive care and medical-surgical units were experiencing similar problems with blood draws. Working with the laboratory director, clinical leaders in those departments were able to use real-time data and rapid-cycle improvement to quickly address the problem. “They want to see what's going on in their unit,” Pelletreau says. “Health care professionals want to get it right.”

Pelletreau points out that the events flagged by the EHR surveillance are recognizable to frontline staff because they occurred recently and often confirm their own sense of ongoing risks to safety in their care processes. This recognition sparks initiative and engagement among staff, including some who were skeptical about the value of data or tended to defer to their hospital or unit’s safety personnel for solutions to problems exposed by adverse events.

New systems transform trusted “trigger” methodology

EHR surveillance evolved from a method that retrospectively searches for “triggers” in a limited number of patient records through manual review. Those triggers, or clues, are used to identify potential adverse events, which can then be further analyzed to determine if and how harm has occurred.

Automating the trigger methodology brings it into real time and expands its reach to all patients’ clinical records to improve detection. The use of software permits the efficient application of these triggers more broadly and at more granular levels of patient care. Because automated surveillance is sensitive to the early stages of a possible adverse event, it also enables health care workers to prevent and ameliorate harm as well as identify when it has occurred.

Real-time EHR surveillance may signal the next chapter in health care safety by providing a comprehensive, forward-facing view of adverse events, one that is more like looking through a windshield than a rear-view mirror.