Technology’s impact on patient safety: what Google searches reveal about your health, everyone’s role in improving EHRs, and rising cyberattacks against hospitals
“OK Google. Should I See a Doctor?”
When you don’t feel well, what’s the first thing you do? Do you call your physician, or do you consult Dr. Google? Many people would rather search for their symptoms online than go to the hospital. But now, a team of researchers at Penn Medicine’s Center for Digital Health is turning to Google—for information about their patients. Specifically, they’re inter- ested in learning what questions patients ask the popular search engine, especially in the days and weeks leading up to a hospital visit or procedure, as a potential way to better un- derstand the person and what they need. The theory is that our “social mediome”—a term Penn researchers have coined for our digital footprint—may provide relevant information that can ultimately improve patient diagnoses and care.
In February, BMJ Open published the Penn study, “Google search histories of patients pre- senting to an emergency department: an observational study,” which reviewed more than 600,000 search queries from the 103 participants of the study. Researchers found that health-related questions make up 6% of overall searches, but that figure more than dou- bles in the week before a trip to the ER. However, as every person generates a tremendous amount of data to process, the study’s lead author, Jeremy Asch, points out that this only adds to the whole picture of a patient. The true value of knowing how people interact with Google about their health may lie in learning how healthcare providers can better interact with their patients.
That is, if people are even willing to open up their Google search history. Of the 703 pa- tients invited to participate in the study, only half of those eligible for it agreed to share their data with researchers.
Behavioral Health — Safety Officers Soothe Patient With Song
Sergeant Keith Miller, a safety officer at Loyola University Medical Center in Maywood, Ill., knows that “a spoonful of sugar helps the medicine go down”—and in his line of work, taking Mary Poppins’ famous advice to heart has helped him avoid harm to patients, families, and care providers.
When Walker Hughes arrived at Loyola in late December, the 33-year-old au- tistic man was agitated and violent, after having an unexpected reaction to medication that was supposed to calm him. He had attacked his parents, Ellen and Robert, in their home, and as soon as they rushed him to the hospital, he bit his mother’s hand. That quickly got the attention of Miller and his team of safety officers, who sprang into action to protect the elderly couple from their much bigger, stronger son. All too often, situations like this end in tragedy, but this time the scene played out differently.
Walker was uncooperative with efforts to test and treat him, constantly jump- ing off the examination table. But when he mentioned Mary Poppins, Sergeant Miller—who has a 14-year-old autistic son of his own—got the idea to make it all into a fun game. Every time Walker jumped off the table, the safety officers cheered, “Walker gets up!” When they got him back on the table, they cheered, “Walker sits back down!”
They kept the impromptu song and dance going for nearly three hours, keeping Walker smiling and calm while doctors checked him out. “Very few things were more important than Walker,” Miller told
Campus Safety magazine. He also emphasized the importance of more police and safety officers receiving proper training to work with patients with autism, as the number of children diagnosed with autism continues to grow. Though, Ellen, impressed with the officers’ creative approach to helping Walker, averred, “You can’t train that kind of spirit.”
Long-Term Care — Senate Hearing on Nursing Home Safety Following Recent Reports of Abuse
In response to recent, shocking reports of improprieties and elder abuse at nursing homes, Senator Chuck Grassley, chairman of the Senate Committee on Finance, called for a hearing on March 6 to explore the factors contributing to the ongoing problem, and begin a discussion of possible solutions. Two daughters of victims of abuse or neglect shared their mothers’ heartbreaking stories, and expert witnesses—including Dr. Kate Goodrich, director and chief medical officer of the Center for Clinical Standards and Quality, Centers for Medicare & Medicaid Services (CMS), and Antoinette Bacon, associate deputy general and national elder justice coordinator, Department of Justice—deliv- ered testimonies on the troubling topic. The hearing came one day after CMS
announced stricter standards for its nursing home rating system. Watch the recorded hearing and read statements from its participants at
www.finance. senate.gov/hearings/not-forgotten-protecting-americans-from-abuse-and-ne- glect-in-nursing-homes.
Surgery — “MD Too”: When Women Surgeons Face Bullying and Sexual Harassment, Patients Also Suffer
When it comes to sexual harassment and
bullying in the workplace, the direct victim of harassment isn’t necessarily the only one who suffers. If their workplace is a healthcare facility or an operating room, for example, patient safety also can be at risk.
A recent study presented at the Academic Surgical Congress in February,
“A National Survey of Sexual Harassment Among Surgeons,” found that 58% of women surgeons surveyed from April to July 2018 had experienced sexual harassment in the previous 12 months, and 14% had been sexually assaulted by someone from work—but only 16% reported either incident to an author- ity. Of those who did report sexual harassment or assault, 53% said that no action had been taken. Residents and fellows were more than twice as likely as faculty to be harassed, which is an indicator of why harassment often isn’t reported: the victim is worried about losing their job or opportunities, or they expect that nothing will be done to correct the situation.
Dr. Heather Logghe, a surgical research fellow at Thomas Jefferson University, and founder of the
#ILookLikeASurgeon movement,
points out the negative impact harassment has on patient safety. Since victims tend to avoid their harassers, they would also limit their communications around patient care, compromising patient safety. The distraction of harassment could have a dan- gerous impact in an OR setting, and could affect clinical decision-making. Logghe also notes that such harassment often influences the fields women choose to work in, which may keep more women surgeons out of the OR in the first place. Yet a commentary published in January in Annals of Surgery,
“Workplace Bullying Among Surgeons—the Perfect Crime,” suggest that bully- ing is an ongoing, major concern in the surgical field, from operating rooms to conferences, and there are few protections against it.
While it’s increasingly clear that sexual harassment and bullying have no place in society, let alone workplaces, it’s especially important to make hospitals a safe space for everyone—healthcare providers and patients alike.
Patient Perspective — EHR: Everyone Has Responsibilities
While the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act spurred the widespread and rapid adoption of electronic health records (EHR) by medical facilities,
in the last decade there has been no universal method of implementing them. Even within Epic and Cerner—which combined account for more than half of the EHR systems in use today—vari- ations in their interface and how they interact with other systems result in wildly different configurations and end-user experiences across healthcare fa- cilities. These differences could mean it takes 25 seconds to complete an im- aging order at one facility but more than 60 seconds at another, or eight clicks at one and 31 at another. It also means that one site may report no medication errors, but another using the same EHR may have a 30% error rate.
To help address these discrepancies and related concerns, the American Medical Association (AMA) and MedStar Health National Center for Human Factors in Healthcare have joined forces to launch a
website to raise awareness of the role everyone, from physicians to patients, can play in improving the effective- ness, efficiency, usability, and safety of EHRs. The focus is on ensuring that vendors developing and delivering EHR systems can be informed of usability issues, and that those who purchase and work with an EHR understand us- er-centered design and the impact it can have on patient care and physician burnout. The AMA/MedStar website, aligned with the results of an
AMA-fund- ed, multicenter study analyzing EHR usability and safety last year, presents videos demonstrating problems potentially associated with EHR systems and explains what healthcare providers, professionals, and policy makers, as well as EHR vendors and patients, can do to help improve these systems, such as participating in safety tests and reporting usability issues and errors.
Infection Prevention — No Vaccine, No Service
As the nation is buzzing about the return of measles and mumps out- breaks in multiple states and debates over vaccination rage on, one South Carolina doctor is taking the safety of his patients to a new level. Dr. Marc Bahan of CPG Pediatrics in Myrtle Beach, S.C.,
has closed his office to patients who refuse to vaccinate. This shift in policy has left the practice’s existing, unvaccinated patients unhappy, but Bahan insists that it is a necessary precau- tion to protect immunocompromised pediatric patients; for example, measles could be deadly to a cancer patient receiving chemotherapy.
“Having unvaccinated children coming to a pediatric office where lots of chil- dren are at a very high risk for contracting vaccine-related diseases just seems inappropriate,” Bahan recently told NBC.
Check out a video from Dr. Zubin Damania, aka ZDoggMD, for some helpful tips on recognizing and managing measles.
New Online Training in Infection Prevention and Control for Nursing Home Staff
The Centers for Disease Control, in collaboration with the Centers for Medicare & Medicaid Services, has launched a new online course with free continuing education credits:
Nursing Home Infection Preventionist Training. It consists of 23 modules and submodules that can be completed in any order at your own pace, covering the core activities of effective infection prevention and control (IPC) programs, IPC best practices, and how to use a variety of IPC implementation resources. The training course is now available on
CDC Train.
Medication Safety — Drug Shortages: Shortchanging Quality, Safety
Drug shortages continue to have an impact on the prescribing, dispensing, and administering nodes of the medication use system and destabilize sys- tems built for medication safety. The Pennsylvania Patient Safety Reporting System (PA-PSRS) revealed 455 reports related to drug shortages from July 2004 through June 2018, of which 70.8% detailed events that reached the pa- tient. Authority Analysts will identify actions and processes in the remaining 29.2% of reports in which the error did not reach the patient, seeking insights as to how errors due to drug shortages may be caught or prevented. From the results of this study, analysts will propose risk reduction strategies and revise the PA-PSRS Drug Shortage Assessment Checklist.
Visit
patientsafety.pa.gov on March 22, 2019, to read the full article in the new issue of the Pennsylvania Patient Safety Advisory, Volume 16, No. 1.
From the Pennsylvania Patient Safety Advisory
Technology — Cybersecurity Critical to Patient Safety
Add cybersecurity to the list of patient safety concerns for hospitals. With the rise of ransomware attacks at hospitals—in which hackers compromise data and systems, holding electronic health records and data in the best-case scenario, or causing delays in delivering care in the worst-case—it’s import- ant that hospitals proactively invest in improving their technology and online security, or they and their patients may pay a much higher price later. The growing trend of the “internet of things,” which uses web-enabled medical de- vices (such as wireless pacemakers and insulin pumps) to connect patient and their data with their doctors, puts patients even more at risk for exposing or exploiting sensitive information about them and their health.
This isn’t a simple challenge to tackle, requiring hospitals, the healthcare sup- pliers, and even the healthcare system itself to step up and take responsibility to develop and acquire better products, and spend time and money to make sure they are set up securely and people are trained to use and maintain them.
