There has been considerable growth and sophistication in the world of Safety and Quality in Australia and internationally. There are many well documented and specific elements to the safety and quality process such as auditing, standards, guidelines and education plus a steadily increasing commitment of resources and expenditure to ensure the achievement and maintenance of safety in health care. Still far from perfect, significant achievements have been put in place and are making a difference.
A number of hospitals are approaching ‘digital hospital’ status and there is an exponential growth in all manner of health care applications from mobility, advances in telehealth, home monitoring and complex messaging relating to interoperablity between facilities, specialists and primary care services.
It is my belief that eHealth will need an equal or larger commitment to clinical safety into the future. There are many aspects that will need long term management.
These include though not limited to:
The clinical safety of applications, system interactions and interfaces
The currency of reference terminologies and guidelines
Ongoing review and currency of evidence justification for digital clinical pathways, guidelines, rules and templates.
Ongoing governance of Clinical Decision Support system rules that are in place or being introduced. Deprecation of rules will also be essential.
Essential and innovative auditing processes will need developing to examine and improve the system outputs and inputs including medications, letters, summaries, results, reports etc.
Managing clinical aspects of coronial and external investigations of adverse events related to information systems
Reporting and KPI analysis for Safety Commissions and facility accreditation, plus inevitable political concerns
Ensuring that clinical risk aspects are identified, managed, documented and demonstrated to have been resolved or mitigated for the future.
As the Digital Hospital culture grows across the nation, ensuring that appropriate training curricula and updates are managed and in harmony, particularly as clinicians move between different facility based systems
Monitoring the safety, messaging content of integrated Point of Care and procedural device safety (e.g. robots, scanners and genomics)
Putting in place quality audits of the increased textual components in the various modules and overall professionalism of the clinical content
Reviews of the success or failures of the integration aspects in regard to semantic interoperability and data accuracy of the various systems, small and large, local and cloud, fixed and mobile.
Ensuring telehealth and remote systems are accurately recording event episodes and that the records are synchronized across aspects such as allergies, alerts, procedures, medication changes etc.
Determining and monitoring that the validity of third party (clinical data) is safely integrated and input (i.e. Primary Care, International, Private Sector).
In a similar structural way that the clinical Safety and Quality movement has dedicated teams, independent or preferably integrated, with existing structures, I believe this needs to occur within the clinical informatics domain. While both movements need to move in harmony, new sets of skills will be needed along with education, accreditation guides, auditors and a host of research activities. All these functions will need to be networked with a central functioning safety body to ensure consistency and integration as well as leadership, training and career development.
Then we should all feel safer when the machine asks us how are you feeling today!