Department of Defense. Excerpts from Failure Mode and Effects Analysis in Health Care: Proactive Risk Reduction. Coding Heart Procedures in ICD-9-CM and ICD-10-PCS, http://www.ihi.org/resources/Pages/Changes/ImproveCoreProcessesforDispensingMedications.aspx, http://2013.march.qualityandsafetynetwork.com/downloads/JCR3_13_Risky_Business.pdf, http://www.mddionline.com/article/use-and-misuse-fmea-risk-analysis, http://www.patientsafety.va.gov/docs/hfmea/HFMEAIntro.pdf, http://www.sre.org/pubs/Mil-Std-1629A.pdf. Department of Education eHR Post-Implementation Review Executive Summary 1 REVIEW OF: eHR Post-Implementation DATE: Fieldwork performed June 2013 – July 2013 REVIEW RATING: Acceptable [ X ] Marginal [ ] Unacceptable [ ] INTRODUCTION: In connection with the Department of Education’s (DOE) updated Risk … Risk management is a required curriculum competency by CAHIIM. Stu… © Copyright AHIMA 2020. Outsourcing is another popular approach in risk transferring. If the hospital has limited experience in data conversion during EHR implementation, it can contract out this work to a data conversion specialist. [content no longer available at this link]. Choosing the EHR implementation process is an ideal example to illustrate the application of FMEA. Each risk item has its critical date, such as with EHR implementation, where some risk items are approaching, while others are not urgent. The role of a Project Manager is generally a full-time job; it cannot be accomplished in someone’s spare time. Yet another approach, published by Mike W. Schmidt in Medical Device and Diagnostic Industry, argues that detectability in risk assessment is suitable in manufacturing, but detection of a hazard during use of a particular device does not ensure the harm will be avoided.8 Therefore, in recent healthcare studies the risk score contains only two factors.‑9,10 For example: Just as the methods of FMEA vary in different texts, there is currently no standardized process in actually conducting the FMEA process. “The importance of clinical staff engagement is an ongoing management challenge, as the degree of clinical functionality in the EHR and required care process documentation is ever-increasing.” For example, the Institute for Healthcare Improvement’s (IHI) Idealized Design of Medication Systems (IDMS) team used FMEA to evaluate the medication-dispensing process. He offered six best practices to minimize the effect of an EHR implementation on revenue. Increasing importance of EHR-related risk-mitigation strategies. The ranking legend below Table 1 is used to decide whether this risk item is assessed as high, medium, or low risk in the EHR implementation project. 2003. The next step involves the development of a risk response plan for each of the risk items. health information management and Project Manager . Veterans Affairs National Center for Patient Service. For this risk factor, the cause may be simple—insufficient training due to neglect on the part of management. 2001. http://www.fmeainfocentre.com/presentations/fmea_requirements.ppt?. For this reason, it is critical to include personnel … 3 Joint Commission on Accreditation of Healthcare Organizations. In this article, we present a “red‐flag”‐based approach that can be used by risk managers to identify potential EHR safety concerns in their institutions. Medical Device and Diagnosis Industry.” March 2004 issue. What are the 41 "worst practices" in healthcare project management and how can we minimize or eliminate their use on EHR systems projects? Below, the authors use an arbitrary example of electronic health record (EHR) implementation to illustrate the application of FMEA in risk management. As a risk management strategy, OMIC recommends carefully working with your EHR vendor to verify that reporting requirements for your practice are being met and, once your system is adopted, performing ongoing reviews of reports before releasing them to others. American Hospital Association. Following FMEA, IHI proposed an activity list which is used to improve the process for dispensing medications.5, The methods of FMEA vary in different texts. The authors reviewed current textbooks and journal articles and did not find sufficient practical examples for student use. The team reviewed these steps for failure modes and assigned a risk priority number (RPN) to each step. 2003. EHR Project Management - Introduction . http://www.ihi.org/resources/Pages/Changes/ImproveCoreProcessesforDispensingMedications.aspx, http://www.mddionline.com/article/use-and-misuse-fmea-risk-analysis, http://www.patientsafety.va.gov/docs/hfmea/HFMEAIntro.pdf, http://www.sre.org/pubs/Mil-Std-1629A.pdf, WARNING Health IT May Be Hazardous to Your Healthcare: New Health IT Hazard Manager Helps Providers and Vendors Track Electronic Health Systems’ Side Effects, Minimizing Hybrid Records: Tips for Reducing Paper Documentation as New Systems Come Online, Application of Data Security for Electronic Health Information, Ranking: High > 75, Medium > 50, Low < 50, Constructing a detailed flow chart of the process, Determining each step that can “fail” and how it can “fail”, Determining the “effect” of each possible “failure”, Determining how serious the possible effect(s) can have on the patient—criticality, Conducting root cause analysis of top failure modes, Brainstorm actions that could reduce the criticality index. Following FMEA, IHI proposed an activity list which is used to improve the process for dispensing medications.5. Implementing an electronic health record (EHR) has the potential to enhance healthcare delivery and expedite reimbursements. Risk identification methods include brainstorming, Delphi technique, interviews, root cause analysis, SWOT analysis, and experience. Risk management aims at lowering the probability of risks and alleviating … According to the above table, the risk management team can assess each risk item’s probability, then risk score. 5 Institute for Healthcare Improvement. Risk identification methods include brainstorming, Delphi technique, interviews, root cause analysis, SWOT analysis, and experience. Many healthcare organizations are undertaking EHR implementation projects or updating information technology processes. Department of Defense. This 9-step module can help your practice plan for a smooth transition from paper records to an EHR system. p. 56. FMEA is used to identify the location, cause, and consequences of potential failure, for the purpose of reducing the chance of failure.2 While the origin of FMEA can be traced back to the 1970s, FMEA was gradually adopted for the healthcare industry by the American Hospital Association (2002) and The Joint Commission (TJC) at the turn of the century.3 Use of FMEA in healthcare is growing, particularly since … 9 Reiling, J. G. et al. Ambulatory EHR Implementation Project Management Components. The risk management team should pay more attention to risk factors assessed as high to medium to alleviate its impacts. 4 Kelly, D. Applying Quality Management in Health Care: A Systems Approach. According to the above table, the risk management team can assess each risk item’s probability, then risk score. “Improve Core Processes for Dispensing Medications.” http://www.ihi.org/resources/Pages/Changes/ImproveCoreProcessesforDispensingMedications.aspx. This article illustrates how to conduct risk management with the popular risk management tool FMEA and create the risk register, utilizing EHR implementation as a case illustration. An organization that routinely conducts EHR‐related surveillance activities, such as the ones proposed here, can significantly reduce risks associated with EHR implementation and use. The Joint Commission proposes a risk priority number (RPN) method, which is the same as the CI score described above, except that the scale for each factor ranges from 1–10.7. Health information management practitioners can master the knowledge and fundamentals from this example and utilize the risk management tools in other HIM practices. FMEA is used to identify the location, cause, and consequences of potential failure, for the purpose of reducing the chance of failure.2 While the origin of FMEA can be traced back to the 1970s, FMEA was gradually adopted for the healthcare industry by the American Hospital Association (2002) and The Joint Commission (TJC) at the turn of the century.3 Use of FMEA in healthcare is growing, particularly since a requirement was added to the Joint Commission standards that healthcare facilities identify and conduct at least one FMEA on a high-risk process every year.4 FMEA has been used by hundreds of hospitals in a variety of healthcare programs. 2002. Therefore, assessing the severity and probability of each risk item with FMEA is the identification and assessment segments of risk management. The next step involves the development of a risk response plan for each of the risk items. As part of an iterative process, the risk tracking tool is used to record the results of risk prioritization analysis (step 3) that provides input to both risk mitigation (step 4) and risk impact assessment (step 2).The risk mitigation step involves development of mitigation plans designed to manage, eliminate, or reduce risk to an acceptable level. Risk mitigation planning, implementation, and progress monitoring are depicted in Figure 1. 6 Spath, P. L. Using failure mode and effects analysis to improve patient safety. One approach, published in the AORN Journal, proposes a critical index score, which is calculated as follows: Critical Index (CI) score = Severity × Probability × Detectability, For each of the factors, a scale of numbers ranging from 1 to 5 is assigned. To illustrate FMEA, this article will focus on the next steps in the analysis, which consist of risk assessment and control. Change management is the basic foundation underlying all phases of the EHR implementation lifecycle and helps achieve EHR Meaningful Use and practice transformation. Health information management (HIM) students need to be able to analyze risk management scenarios in various HIM practices to control or prevent risk where possible. In the case illustration of EHR implementation, the root cause of inadequate training is examined as one risk included in the risk register (shown in Table 3). In addition, the server must have a security system … 2nd edition. It is important to note that the team will need to continue monitoring and updating the register weekly or monthly. • Identify patient safety and compliance risks associated with electronic health record (EHR) implementation, use, and maintenance • Discuss strategies and best practices to ensure safe patient care and an effective, efficient, and defensible medical record • Explain how an EHR … Health information management practitioners can master the knowledge and fundamentals from this example and utilize the risk management tools in other HIM practices. An analysis of workflow has been completed because EHR implementation projects are generally led by a professional project team. publication of the American Health For example, the risk score of inadequate training is found in Table 2. Military Standard: Procedures for Performing a Failure Mode, Effects and Criticality Analysis. “Electronic health record system risk assessment: a case study form the MINET.”. timeliness, privacy, and security of Several tools are available in risk management, including root cause analysis, FMEA, and risk register. Many healthcare organizations are undertaking EHR implementation projects or updating information technology processes. Health information management (HIM) students need to be able to analyze risk management scenarios in various HIM practices to control or prevent risk where possible. Successfully implementing an EHR system requires a multi-disciplinary approach — from ensuring privacy and security compliance to rethinking practice workflows and training staff. For example, with system incompatibility, the organization can allocate more capital resources to replace obsolete systems. FMEA is used to identify the location, cause, and consequences of potential failure, for the purpose of reducing the chance of failure.2 While the origin of FMEA can be traced back to the 1970s, FMEA was gradually adopted for the healthcare industry by the American Hospital Association (2002) and The Joint Commission (TJC) at the turn of the century.3 Use of FMEA in healthcare is growing, particularly since a requirement was added to the Joint Commission standards that healthcare facilities identify and conduct at least one FMEA on a high-risk process every year.4 FMEA has been used by hundreds of hospitals in a variety of healthcare programs. Information Management In addition, during the risk monitoring, the project team needs to watch for new risks, especially when the project scope, schedule, or environment changes. Avoiding a risk is to ensure the risk will not happen by changing the plan or process. By Tiankai Wang, PhD and Jackie Moczygemba, MBA, RHIA, CCS, FAHIMA: This article illustrates how to conduct risk management with the popular risk management tool FMEA and create the risk register, utilizing EHR implementation as a case illustration. Choosing the EHR implementation process is an ideal example to illustrate the application of FMEA. Retrieved on 4/17/2014 from http://www.mddionline.com/article/use-and-misuse-fmea-risk-analysis. The team will usually consist of a project manager, sponsors, and representatives from each department/unit. The purpose of risk management is to reduce the chance of failure. Hospital Accreditation Standard, LD 5.2. Finally, if nothing can be done, the organization will have to accept the risk. People affected by new processes are often not aware of upcoming changes or how new processes will impact their work. Using the process proposed by VA NCPS, the first three steps are assumed. How long does EHR implementation take? 8 Schmidt, Mike W. “The Use and Misuse of FMEA in Risk Analysis. 2015. Who Has Rights to a Deceased Patient’s Records? By Tiankai Wang, PhD and Jackie Moczygemba, MBA, RHIA, CCS, FAHIMA, Risk management is defined as “the act or practice of dealing with risk, which includes planning for risk, assessing, identifying and analyzing risk areas, developing risk-handling options, monitoring risks to determine how risks have changed, and documenting the overall risk management program.”1 The goal of risk management is to lower the probability of risk and alleviate risk impacts. Disclaimer The material in these guides and tools was developed from the experiences of Regional Extension Center staff in the performance of technical support and EHR implementation assistance to primary care providers. 78(1), 16-37. Download PDF. The risk team needs to assess all risk items and input them into the risk register, as illustrated in the following table. "It was six consecutive marathons," said McDermott. Read more . For example, in an EHR implementation project, purchasing additional billing insurance can alleviate the potential negative impacts due to billing errors during use of the new EHR system. EHR Implementation Security & Risk Assessment Guide. Given the broad impact that some of the ARRA provisions may have, such a risk analysis is best integrated into an enterprise-wide risk management effort (ERM) that includes a multi-disciplinary and multi-divisional approach. issues that affect the accuracy, The practice of embedding guidelines, such as Choosing Wisely®, in EHR systems is a common concern among physicians. Thus, the most severe, most probable, and least likely to be detected potential error event is the highest ranked event. JOURNAL of AHIMA—the official Risk Management in EHR implementation. Some risks, such as data privacy compliance, will not influence the project for 6 months, so the current status may be noted as “not applicable” until further information is obtained and the timeline is reached. For example, the Institute for Healthcare Improvement’s (IHI) Idealized Design of Medication Systems (IDMS) team used FMEA to evaluate the medication-dispensing process. Medical Device and Diagnosis Industry.” March 2004 issue. Healthcare managers can be flexible in deciding on the FMEA process steps based on the process under review. 2002. The Veterans Affairs National Center for Patient Service (VA NCPS) interpreted the TJC requirement in the Leadership 5.2 standard as needing five steps:11, To further illustrate differences in conducting the FMEA process, Darryl S. Rich, the surveyor of TJC, specifies the following six steps:12. For example, with system incompatibility, the organization can allocate more capital resources to replace obsolete systems. Spath, P. L. 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