In June 2004, Pennsylvania began implementing the first statewide mandatory reporting system in the nation. All hospitals, ambulatory surgical facilities, and birthing centers licensed by the state now report through the new Pennsylvania Patient Safety Reporting System (PA-PSRS).
The Patient Safety Authority, an independent agency of the Commonwealth of Pennsylvania, developed PA-PSRS (pronounced "PAY-sirs") in response to Act 13 of 2002, which charged the Authority with taking steps to reduce and eliminate medical errors by identifying problems and recommending solutions that promote patient safety. Pennsylvania is the first state in the country to require the reporting of both actual events and "near-misses." More than 400 healthcare facilities in Pennsylvania are subject to Act 13 reporting requirements. All information submitted through PA-PSRS is confidential, and no information about individual facilities or providers will be made public.
The PA-PSRS program will receive and tabulate reports and analyze data to identify trends and suggest improvements to enhance patient safety. The Authority will make available to the public aggregate data related to both certain geographic regions and the state as a whole, but will not release facility-specific data. An important component of PA-PSRS is a software program that will allow facilities to generate reports specific to their individual facility. Facility managers can use these reports for their internal quality improvement and patient safety activities.
Prior to the start of mandatory reporting, the Authority conducted 19 training sessions in 11 locations throughout the state. Almost all facilities subject to Act 13 reporting requirements participated in these daylong demonstration and hands-on training sessions.
"PA-PSRS program staff worked aggressively over the past several months to ensure that the implementation of PA-PSRS went as smoothly as possible," said Dr. Robert Muscalus, Pennsylvania's physician general and chair of the Authority's Board of Directors. "We initiated mandatory reporting in three steps to assure ample time to train facilities on the use of the system prior to the start of mandatory reporting. We are pleased with how well this has gone."
Mandatory reporting was initiated among facilities in eastern counties on June 7, among facilities in western counties on June 21, and among facilities in counties comprising the central region of the state beginning June 28.
"For many facilities, this is the first time they have access to an electronic system to track events in their facility," Muscalus said. "Many personally thanked us for bringing a tracking system into their facility. Others commended us for the comprehensiveness of PA-PSRS."
In submitting reports, a facility must answer a variety of questions about the circumstances surrounding an event, including the level of actual or potential harm to the patient as well as such factors as staffing or equipment problems that may have contributed to the occurrence. The result is a detailed database that will allow the Authority to identify trends among facilities and recommend improvements that individual facilities may adopt.
"I think the most promising aspects of the PA-PSRS program are the analytical features that allow us to focus on events occurring in specific care areas and enable us to get a better view of the overall picture in our facility by comparing ourselves through aggregate statewide data," said Dr. Douglas Megill, patient safety officer, Warren General Hospital. "Such an improved picture should help us provide better healthcare for our patients."
Many facilities expressed similar views about the quality and usefulness of the PA-PSRS system. In response to an anonymous survey of facilities trained on PA-PSRS, comments ranged from "Very nice system. Easy to use with lots of helpful hints. Love the analytical data tools" and "Thanks for your tremendous effort in improving patient safety" to "I think this is the first time a program has been put together with enough input, discussion, and understanding of needs."
Muscalus added that the enthusiasm from facilities for reporting and analyzing events will make the true difference in improving safety in their facilities. "I've said time and time again in training sessions and during other presentations that the ultimate success of this reporting system will not be found solely in the data collected," Muscalus said. "Rather, improved patient safety will be the result of actions taken by individual facilities in response to what they learn through PA-PSRS."
The Patient Safety Authority is an independent state agency created by Act 13 of 2002, the Medical Care Availability and Reduction of Error ("Mcare") Act. The Authority operates under an 11-member Board. Under the Act, all Pennsylvania-licensed hospitals, birth-
ing centers, and ambulatory surgical facilities are required to report what the Act defines as "serious events" and "incidents" to the Authority.
In addition, Act 13 also requires that the Department of Health receive certain reports through the PA-PSRS system, including information related to Chapter 51 reporting requirements. Accordingly, the Authority worked closely with that agency to assure that PA-PSRS captured all of their statutory and regulatory reporting requirements. In particular, the Authority expanded the system's capacity to include the submission of "Infrastructure Failure" reports to the Department of Health, even though those reports fall outside the scope of the Authority's responsibility. This assures that facilities have a single portal for the submission of various types of reports and creates a unified reporting tool for the agencies involved.
PA-PSRS is a secure, Web-based system developed for the Authority under contract with ECRI, a Pennsylvania-based independent, non-profit health services research agency, in partnership with EDS, a leading international, information technology firm, and the Institute for Safe Medication Practices (ISMP), also a Pennsylvania-based, non-profit health research organization.
For additional information about the Patient Safety Authority or the PA-PSRS program, visit its Web site at www.psa.state.pa.us/psa/site/default.asp
2004 HIMSS Survey Finds Industry Supports NHII, But Challenges Remain
The formation of a National Health Information Infrastructure (NHII) is an initiative healthcare professionals know about, but may not be actively participating in, according to results of the 2004 HIMSS National Health Information Infrastructure Survey, supported by the Medical Records Institute and the HIMSS Foundation. Conducted in April 2004, the survey was designed to obtain a snapshot of healthcare professionals' views on the creation of an NHII.
Background on the NHII: The National Committee on Vital and Health Statistics (NCVHS) issued a report in January 2002 recommending the development of the NHII. Interest in the NHII and subsequent activity resulting from the NCVHS report have continued throughout the past two years.
In addition, development of a national health information infrastructure has gained new prominence with President Bush's recent goal of access for most Americans, in the next decade, to electronic medical records (EMRs) as described in the President's Executive Order signed on April 27, 2004. In May 2004, David J. Brailer, MD, PhD, was appointed as the first National Coordinator for Health Information Technology. Dr. Brailer reports directly to the Secretary of Health and Human Services and is responsible for coordinating all federal government healthcare information technology initiatives. As part of his duties, Dr. Brailer presented a strategic plan at the NHII Conference July 21-23, 2004, in Washington, D.C. This survey was conducted before these most recent events occurred.
"The establishment of a National Health Information Infrastructure demands that all segments of the healthcare industry work together to reach this goal in the most effective and efficient manner," said C. Martin Harris, MD, chair of the HIMSS NHII Task Force and CIO of the Cleveland Clinic Foundation in Cleveland, Ohio. "Each healthcare organization may have information technology requirements specific to its own operation, but the basic exchange of patient data in any setting depends upon the guidelines the NHII will provide."
Familiarity with the NHII: Nearly half (42%) of respondents are familiar with, but are not participating in, the development of the NHII, as outlined by NCVHS in January 2002. Another 7% of respondents are actively participating in the development of an NHII.
Facilities included in a national exchange of medical information: Respondents were most likely to identify hospitals and ambulatory care facilities as the type of facility that should be included as part of a national medical information exchange.
Public health information exchange: Nearly 80% of respondents presently indicate that they communicate information to public health agencies. Information about reportable diseases, such as SARS, is most frequently
communicated.
Patient access to online information/services: Patient access to online services is limited. Nearly half of the respondents report that their organization does not provide patients with online services, such as the ability to order a prescription refill. Only 20% indicate that their organization offers patients portal access to online services. Over 80% of the respondents who do not offer online portal access, a step toward a personal health record, indicate that this is because patients have not requested this service.
Barriers to creating the NHII: Lack of agreed upon policies regarding access to patient information and lack of standards to support data sharing are two top barriers to the creation of an NHII. Respondents also identified the lack of defined return on investment, HIPAA privacy/security issues and lack of interoperability as key barriers.
Data standards in use: Respondents are using at least one standard to electronically communicate data to public health agencies and outside organizations. The three standards most frequently used are ICD-9, CPT and the HL7 Message Format Standards.
Conclusions: Almost half of the respondents (43%) to this survey indicate they are aware of the National Health Information Infrastructure compared to a smaller number (28%) of respondents who answered a similar question in an October 2003 HIMSS Vantage Point Survey. A direct comparison cannot be made since the samples were not identical, but in general, awareness of and the need for a NHII have increased in those six months.
To establish an effective National Health Information Infrastructure, certain challenges must be overcome. These include the development of common terminology, interoperable data standards, and industry-wide policies/procedures for access to patient information, privacy and security of patient data as well as a demonstration of return-on-investment for healthcare organizations.
Methodology: Conducted in April 2004, the 2004 HIMSS National Health Information Infrastructure Survey was a Web-based survey of healthcare professionals designed to obtain a snapshot of their views on the creation of a national health information infrastructure. Members of HIMSS and the Medical Records Institute, and other health information technology professionals received an e-mail invitation to participate in the survey. HIMSS members also received information on the survey in HIMSS electronic newsletters and other health IT professionals could access the survey through a portal on the HIMSS Web site. A total of 413 usable responses were received.
