By John Palmer
Editor’s note: The following Q&A resulted from a conversation with Christopher Dore, senior product manager with Capsule Technologies. Dore addressed questions about the patient safety trends that hospitals will need to deal with in the next 20 years, as well as a quick look at the last 20.
Q: First, let’s take a look back. What do you think are some of the biggest breakthroughs in patient safety in the last 20 years, and how do they affect patient care today?
Christopher Dore: The adoption of electronic health records (EHR) has really driven a major change in how we deliver care. One of the biggest breakthroughs in terms of patient safety is how we can leverage patient data in real time to make better care decisions. A recent KLAS report, Clinical Surveillance 2018, indicates that “clinical surveillance tools hold the promise of giving caregivers clinically actionable insights that decrease mortality, reduce readmissions, and improve overall patient outcomes, and clinicians expect these alerts to be embedded directly within their workflow.”
Preventing adverse events before they happen not only optimizes patient outcomes but eliminates the costly side effects of reactive patient safety, including emergency transfers or escalations in care, increased resource utilization, extended length of stay, and hospital readmissions. Continuous clinical surveillance offers hospitals the opportunity for immediate and predictable patient safety improvements that can be scaled and amplified across the enterprise.
Q: That being said, what do you think are some of the biggest safety trends care providers will have to address in the next 20 years?
Dore: The widespread connectivity of electronic devices such as MRI machines, anesthesia machines, ventilators, and pumps has opened the door to more nefarious and indiscriminate cybersecurity attacks. Most of these devices have been designed, purchased, and deployed in a time when cybersecurity was not a consideration for vendors and hospitals. Because of that, hospitals use a significant number of legacy systems that likewise were not conceived with modern security strategies—or in some cases, not much security at all. Though these systems and devices may come with obsolete approaches to security, they store valuable information and play an essential role in patient care. They would be extremely expensive to replace, a situation that essentially forces hospitals to manage as best they can in difficult circumstances. For most of the medical devices and systems they must work with, hospitals are [taking] a reactive stance. The good thing we are observing, though, is most hospitals are now well aware of the risks. [They’ve] started to staff; they are developing specific processes and training; they are deploying security solutions; and, overall, they have a much higher level of scrutiny regarding the security impact of the new systems and devices they onboard.
Over the next few years, hospitals will need to leverage technology to understand and monitor their exposure to security risks, as well as detect any system misbehaviors. These tools can deliver an inventory of all the medical devices in use, match these devices with vulnerabilities that are known to exist, alert users to the potential risks that each device brings, and provide advice on actions to take. Hospitals should be able to perform a benefit-risk analysis for any new devices and systems that are under consideration for implementation.
Over the next 20 years, hospitals will have to focus and invest more in cybersecurity. Healthcare has been behind many other industries while having much more at stake: i.e., patient lives. They should be able to protect their connected systems and devices proactively and pervasively, detect issues early, respond to threats quickly and efficiently, and recover from attacks easily and reasonably inexpensively. The progress path for patient care will rely on data insights for early detection, as well as improved protocol to avoid health issue escalation. Ensuring availability and integrity to data insights will largely be dependent upon a cybersecurity protocol that enables better protection of these data assets.
Q: Some say data analytics and artificial intelligence (AI), as well as technologies such as the internet of things (IoT) and robotics, will replace human interaction with patients in the coming years. Do you view this as safe and a positive thing for healthcare? Why or why not?
Dore: The increased adoption of data, AI, and technologies such as IoT in healthcare has the potential to streamline workflows, bring more efficiencies to processes, improve patient safety and care, and reduce clinical workload. While it’s unlikely that technology will replace human intervention, it does bring the potential to help address predicted shortages in healthcare professionals. For example, according to the “United States Registered Nurse Workforce Report Card and Shortage Forecast” published in the January 2012 issue of the American Journal of Medical Quality, a shortage of registered nurses was projected to spread across the country between 2009 and 2030.
Data-driven technology can help with issues like nursing shortages. For example, taking patient vitals is one of the most critical components of quality healthcare. It can also be one of the most labor-intensive duties that fall upon healthcare providers. Utilizing automated technology that monitors patients and sends validated vital signs to electronic medical records (EMR) right from the bedside, nurses have more time to focus on direct caregiving. This type of enhanced vitals monitoring provides significant benefits for both providers and patients, as charting time is reduced from hours to minutes.
With respect to performant algorithms, such as data analytics and AI, they show great potential in helping clinicians make faster and more informed clinical decisions based on a huge amount of data—the required amount of data these algorithms can process is bigger than what a single person can handle. These algorithms can come as software applications, but we can also foresee them embedded in IoT and or robotic devices. The challenge, though, is to make the data available to these algorithms. They do not need [just] any kind of data: To perform efficiently and safely, they need data that is thoroughly normalized, but also with a high level of integrity and availability. It is critical for hospitals to deploy enterprise-grade systems liberating the data from many sources, especially medical devices, with respect for availability, integrity, confidentiality, and normalization in order to be ready to feed safely the next generation of patient care algorithms. Performance, cybersecurity, high availability, deep normalization, and data source pervasiveness are the key characteristics of such systems.
Q: Let’s talk about the opioid epidemic. Will we ever solve this and put a stop to it? How? And what can hospitals do to stop the problem of drug diversion?
Dore: As the use of data and technology increase in the hospital setting, there will continue to be improvements in monitoring and tracking the use of opioid drugs. The Joint Commission is helping to address the issue of diversion in the hospital setting by educating hospitals [on] how to notice patterns and trends in drug utilization. For example, one of the abuses in opioid diversion is the alteration of written prescriptions. As more hospitals move to e-prescribing, this has the potential to reduce instances where a patient can alter a written prescription or hospital staff can forge prescription pads.
While the industry continues to make progress in opioid abuse, there is also the issue of patient safety in the hospital setting for those who require controlled analgesia. The ECRI Institute named undetected opioid-induced respiratory depression as one of the top 10 health technology hazards for 2017. Patients receiving opioids are at risk for drug-induced respiratory depression, and if left undetected, this condition can quickly lead to anoxic brain injury or death. According to the Association for the Advancement of Medical Instrumentation (AAMI) Foundation, 50% of medication deaths are attributable to opioids, and each year, more than 20,000 patients administered opioids experience respiratory depression arrests—costing the U.S. healthcare system $2 billion each year.
One of the things hospitals can do to protect patients and reduce deaths attributed to respiratory depression is ensure they enable continuous respiratory monitoring of patients receiving sedatives to prevent adverse events, as recommended by both The Joint Commission and the AAMI Foundation.
Q: Antimicrobial stewardship is a major trend in hospitals today, and experts warn of the proliferation of “superbugs” from overuse of antibiotics. Will the problem get worse, and what do hospitals have to do to get it under control?
Dore: Today, hospital clinical leadership is focusing on more direct ways to improve patient safety by increasing continuous surveillance on patients throughout their entire course of stay in the hospital. Continuous clinical surveillance can provide early detection of critical events so care teams can intervene before deterioration occurs. When clinicians have tools that simplify clinical workflow and provide data-driven insights at the point of care, they can make better decision about which course of action to take, including if/when antibiotic intervention is needed.
John Palmer is a freelance writer who has covered healthcare safety for numerous publications. Palmer can be reached at firstname.lastname@example.org.