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Dome - Swift—and Safe—Glitch Management

Dome December 2013

Swift—and Safe—Glitch Management

Date: December 2, 2013


Shortly after the Epic electronic medical record system went live at Sibley Memorial Hospital on June 1, nurses who were administering blood began getting false alerts, indicating that the blood had already been given or that it was reserved for another patient.

The problem: Bar codes on the units of blood referred only to the person who had donated it, so multiple units often carried the same identifier. Although there were no mishaps attached to this glitch, more specific information had to be added by hand, potentially slowing patient transfusions, says Lori Keim, one of Epic’s nurse champions at Sibley, who helped find a solution to the problem.

Epic is now in place at Johns Hopkins Community Physicians, Sibley, Howard County General Hospital and ambulatory care at Johns Hopkins Bayview Medical Center and The Johns Hopkins Hospital. During the rollout of such an enormous and complex system, obstacles and inefficiencies were expected. In the four weeks immediately following each “go-live,” a 24-hour help desk took on the most pressing concerns in a process called “break-fix,” says Stephanie Poe, Johns Hopkins Medicine’s chief nursing information officer.

The challenge now is making sure the highest priority items are handled first and the workload is sensibly distributed, says Linda Kline, executive director of the Epic project. That task falls to select groups of clinicians and operational leaders at each hospital and member organization. These clinical informatics committees (CIC) receive the requests submitted by users, either through an enhancement request or a problem ticket that is not deemed a “break-fix.” They then create a priority list and assign the top concerns to design teams that create enterprise-wide approaches to system improvements.

Patient safety is the top consideration, says Poe. To help guide the CIC in this area, the Armstrong Institute for Patient Safety and Quality has established an evaluation system that weighs severity of potential harm and probability of occurrence. For example, because of the potential for patient harm, the blood documentation issue at Sibley was “immediately classified as high priority,” says Keim, who served on a team that spent several weeks untangling the issue, which involved improvements to Epic’s ability to work with a legacy laboratory management system.

Another deficit in the electronic medical records system posed a threat to patient safety at Johns Hopkins Community Physicians. After Epic was launched at JHCP in April, users began noticing that lab results did not consistently show up in the system. Realizing that this problem could harm patients, particularly those with illnesses requiring quick lab results, a team of lab experts, Epic application team leaders and business owners held daily conversations to identify and fix the problems, says Jennifer Bailey, director of quality and transformation for JHCP.

Now that the most serious Epic issues have been resolved, the clinical informatics committee at JHCP is concentrating on “optimization” requests, such as streamlining workflow and improving functionality. The group of roughly 15 people meets weekly to discuss and prioritize tickets that Bailey says address requests for changes that are “‘nice to have,’ versus ‘need to have.’”

—Karen Nitkin

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