HIM pros can take the lead in reducing errors

Projects would highlight HIM skills

Even if a 1999 government report by the Institute of Medicine in Washington, DC, exaggerated the prevalence of medical errors, health information management (HIM) professionals would be wise to set error-reducing systems in place, says Gwen Hughes, RHIA, practice manager for the American Health Information Management Association (AHIMA) in Chicago. (For more information about the controversy over the report, see cover story.)

One step Hughes recommends HIM professionals take to reduce medical errors is to establish an interdisciplinary task force and charge it with reducing medical errors by 10% a year over five years.

Members of that team might include representative from these areas:

• nursing;

• the medical staff;

• lab and radiology;

• high-risk areas such as the emergency room or operating room;

• quality assurance and HIM departments since they have to get the data and manipulate it.

"The team might be the quality performance improvement team or a subset of that team," she explains.

Hughes says she would ask the facilitator of the group to do a literature search then create a list of potential risk factors that he or she wants to assess and determine how the facility measures up against those risk factors. (For a list of risk indicators in documentation, see story, below.)

Next, the facilitator should identify high-volume, high-risk, and problem-prone areas, and prioritize them. "Consider those risk areas where you have the potential to make the largest improvements the fastest," Hughes says. "At least tackle those the first year."

The facilitator should use the myriad quality improvement and performance improvement tools available to develop an action plan, she continues. Staff would need to be educated about the plan before it was implemented.

If administration is not doing anything about medical errors, the HIM professional should take the lead, Hugh advises. "Go to administration and say, There is a report. We know we have been following these things all along, but perhaps we should make this a formal focus so it becomes a priority for us.’"

Many HIM personnel, particularly those who are skilled project managers or quality improvement people, would be good to facilitate or manage the project, Hughes says.

"We’re good at designing the tools to do quality improvement. We’re good at pulling, collecting, and providing the data. We’re good at explaining the findings and developing action plans and developing programs and tools to educate staff. And a lot of us are good at teaching the staff, too," she adds.

Get other systems in place

Other steps HIM professionals can take to reduce medical errors, Hughes says, include the following:

• Ensure that when handwriting is not legible, there are transcription or voice recognition systems in place that are timely.

• Ensure that transcription turnaround and charting of loose reports are completed in less than 24 hours.

• Ensure that loose report filing turnaround takes less than 24 hours if these functions aren’t automated.

• Ensure, particularly in ambulatory care, that charts are available to the health care providers when the patients present for care.

• Have some kind of computer system available where staff can pull up lab tests, X-rays, and recent progress notes when getting the paper record to appointments is a problem.

• Assure that records are organized and information is easy to locate.

• Facilitate policies that give patients access to their records and the ability to make amendments or corrections to them, even in the states where they don’t have a legal right to their health information.

• Support processes aimed at communicating with patients.

"We should make sure that we are advocates for the patients," Hughes says. "Are they getting what they need from the pharmacy? Are they getting the kind of instructions they need? Are their informed consents really informed? Are they given materials to look at after care or pointed to Web sites so they are not so intimidated by conversations with physicians that might go over their heads?"

• Give patients the opportunity to update their medication allergy list.

"We assume as professionals that physicians and nurses ask that, but I don’t know that they do," she says. "We need to make sure that all new allergies are updated in the record and in other databases."

• Encourage a standardization of systems and protocols.

"I saw my own staff make mistakes when we deviated from the standards," Hughes explains. "One physician or nursing unit wanted us to make an exception. The more exceptions we made, the harder it was for staff to recall the exception. The lack of consistency promoted errors."