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Promoting Patient Safety Through Effective Health Information Technology Risk Management

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Promoting Patient Safety Through Effective Health Information Technology Risk Management Research Report Promoting Patient Safety Through Effective Health Information Technology Risk Management RAND Evaluation Team (Report Authors): Eric C. Schneider, M. Susan Ridgely, Daniella Meeker, Lauren E. Hunter, Dmitry Khodyakov, Robert Rudin Implementation Team: ECRI Institute Co-Team Leads: Karen Zimmer, William Marella Team Members (alphabetical): Chris Callahan, Stevie Davidson, Robert Giannini, Jean Harpel Expert Consultants (alphabetical): Baylor College of Medicine: Hardeep Singh University of Texas: Dean Sittig RAND Health RR-654-DHHSNCH May 2014 Prepared for the Office of the National Coordinator for Health Information Technology This report was sponsored by the U.S. Office of the National Coordinator for Health Information Technology, and was conducted within RAND Health, a division of the RAND Corporation. The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors. Support RAND-make a tax-deductible charitable contribution at www.rand.org/giving/ contribute.html RAND® is a registered trademark. ©Copyright 2014 RAND Corporation This document and trademark(s) contained herein are protected by law. This representation of RAND intellectual property is provided for noncommercial use only. Unauthorized posting of RAND documents to a non-RAND website is prohibited. RAND documents are protected under copyright law. Permission is given to duplicate this document for personal use only, as long as it is unaltered and complete. Permission is required from RAND to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see the RAND permissions page (http://www.rand.org/pubs/permissions.html). RAND OFFICES SANTA MONICA, CA • WASHINGTON, DC PITTSBURGH, PA • NEW ORLEANS, LA • JACKSON, MS • BOSTON, MA CAMBRIDGE, UK • BRUSSELS, BE www.rand.org Preface This research report was sponsored by the U.S. Office of the National Coordinator for Health Information Technology (ONC). It summarizes a project conducted by RAND Health, ECRI Institute, the University of Texas, and Baylor College of Medicine. The project facilitated the identification of safety risks associated with health information technology (IT) by 11 organizations (hospitals and ambulatory practices) and the implementation of risk management activities in each organization. The project also evaluated the implementation effort through site visits and phone interviews. This report summarizes the implementation process, six case studies, and recurring themes from the case studies that offer lessons for risk management of health IT in hospitals and ambulatory practices. The report will be of interest to federal and state policymakers, health care organizations, health IT developers, health services and health policy researchers, and others with responsibilities related to designing and implementing health IT and health IT risk management policies and programs. The research was conducted under contract #HHSP23320095649WC with ONC. The Contracting Officer’s Representative for the project is Kathy Kenyon. We thank the Contracting Officer’s Representative for her guidance and review of this report; however, we note that the material contained in the report is the responsibility of the research team and does not necessarily reflect the beliefs or opinions of the Contracting Officer’s Representative, ONC, or the federal government. This research was conducted in RAND Health, a division of the RAND Corporation. A profile of RAND Health, abstracts of its publications, and ordering information can be found at www.rand.org/health. ii Table of Contents Preface............................................................................................................................................. ii Tables and Figures .......................................................................................................................... v Executive Summary ....................................................................................................................... vi Acknowledgments........................................................................................................................ xiv Abbreviations ................................................................................................................................ xv 1. Background ................................................................................................................................. 1 Health IT Safety Risk Identification and Mitigation ................................................................................ 2 2. Implementation of Health IT Safety Risk Projects ..................................................................... 3 Conceptual Framework: Sociotechnical Context ..................................................................................... 3 Recruitment of Participants ...................................................................................................................... 5 Standardized Process Improvement Strategy ........................................................................................... 5 Resources .................................................................................................................................................. 7 3. Evaluation ................................................................................................................................... 8 Evaluation Objectives ............................................................................................................................... 8 Data Sources ............................................................................................................................................. 8 Interview Participants ............................................................................................................................... 9 Interview Protocol .................................................................................................................................... 9 Theme Identification .............................................................................................................................. 11 4. Results ....................................................................................................................................... 12 Case Study 1: Hospital ........................................................................................................................... 15 Background and Context .................................................................................................................... 15 Health IT ............................................................................................................................................ 15 Health IT Safety and Risk Management ............................................................................................ 16 Project Implementation ...................................................................................................................... 16 Barriers and Facilitators ..................................................................................................................... 18 Utility of Resources and Process Improvement Strategy ................................................................... 19 Case Study 2: Hospital ........................................................................................................................... 20 Background and Context .................................................................................................................... 20 Health IT ............................................................................................................................................ 20 Health IT Safety and Risk Management ............................................................................................ 21 Project Implementation ...................................................................................................................... 21 Barriers and Facilitators ..................................................................................................................... 22 Utility of Resources and Process Improvement Strategy ................................................................... 22 Case Study 3: Hospital ........................................................................................................................... 24 Background and Context .................................................................................................................... 24 Health IT ............................................................................................................................................ 24 Health IT Safety and Risk Management ............................................................................................ 24 Project Implementation ...................................................................................................................... 25 Barriers and Facilitators ..................................................................................................................... 26 iii Utility of Resources and Process Improvement Strategy ................................................................... 26 Case Study 4: Ambulatory Practice
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