Autopilot for healthcare providers automatization methodologies to reduce workload and medical mistakes

MSJAMA: medical mistakes and disclosure: the role of the medical student.

(a) This poster describes background, purpose, scope, structure and function of the Cloud Healthcare Appliance Real-Time (CHART) solution as a service; which is a conceptual suite of information technology (IT) analytics and middleware software, deployed in “the cloud” (i.e. - an Internet-accessible and professionally managed data center) and accessible by licensed healthcare provider subscriber subject matter experts via a secure portal; for the purpose of designing, developing and deploying automated use cases for cognitive support of medical practice and healthcare delivery (e.g. -- differential diagnosis and treatment planning, medical technology alarm/alert fatigue mitigation, patient course-in-treatment management) with minimal cost and complexity. (b) The procedure consists of use case automation design (including definition of required complex event monitoring, natural language-based case/evidence acquisition, Bayesian similarity and predictive analysis, Boolean decision rules, process flow including activities and staff/system actors, and key performance indicator-based process monitoring and continuous improvement enablement) using non-programming techniques such as drag-and-drop; development (including process connectivity to existing provider electronic health records a.k.a. EHRs and other Internet-accessible data sources and services using software-defined networking and HIPAA-compliant encryption/de-identification) with minimal IT professional assistance; and deployment via desktop and mobile digital data devices. The included software already is production-proven in other industries worldwide, so the typical high cost and risk associated with software development projects is avoided. The proposed poster will describe the implementation and utilization of the vendor-agnostic CHART; and how the clinical cognitive support it provides will improve accuracy and speed of oncology diagnosis, will mitigate medical mistakes, will facilitate progress from iterative to sequential treatment through integration of the clinical care and medical learning processes (re Bohner RMJ, “Designing Care …,” Harvard Business Press, Boston, 2009, pp. 128-150), and will ensure much-improved economy, efficiency and effectiveness and for healthcare providers. (c) All available data/information re CHART is available at the web site (www.chartsaas.org) or in the form of presentations (e.g. -- http://bit.ly/28St6MM) and other collateral such as grand rounds solution sheets re central line acquired blood stream infection (CLABSI) and white papers. For example, the benefit of CHART vis a vis the hand-off/sign-out problem (http://1.usa.gov/28UVuAA), is described in our recent Becker's Hospital Review article (http://bit.ly/24k0zov). (d) The urgent need for IT-enabled clinical cognitive support for differential diagnosis improvement, treatment planning and medical mistake mitigation (and most other healthcare provider challenges) can be rationalized as follows: BECAUSE .25M U.S. patients die every year from medical mistake mitigation (http://bit.ly/1rtW6Sa); AND medical mistakes happen because healthcare complexity creates cognitive overload (http://1.usa.gov/291u3mr); THEREFORE cognitive overload requires cognitive support for healthcare providers (http://1.usa.gov/1JXulDM , in particular the testimony of Tejal Gandhi, MD, MPH and Peter Pronovost, MD, PhD); AND healthcare providers need the cognitive support that only information technology (IT) can provide for information management, decision support and process improvement as provided by the CHART solution as a service. Although CHART is only a concept at this point in time, its structure and function have been realized for the most part by commercial off the shelf (COTS) cloud-based intelligent business process management suites (CiBPMS, re http://gtnr.it/28RSLE1). Note: This abstract was not presented at the conference. Citation Format: John Peter Melrose. IT-enabled clinical cognitive support for differential diagnosis improvement, treatment planning and medical mistake mitigation. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C10.

HomeCirculationVol. 101, No. 9President Proposes Steps to Prevent Medical Mistakes Free AccessOtherDownload EPUBAboutView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessOtherDownload EPUBPresident Proposes Steps to Prevent Medical Mistakes Ruth SoRelle Ruth SoRelleRuth SoRelle Search for more papers by this author Originally published7 Mar 2000https://doi.org/10.1161/01.CIR.101.9.e9015Circulation. 2000;101:e9015In response to a devastating report by the Institute of Medicine (IOM) on medical errors, which claimed that such errors kill between 44 000 and 98 000 people each year, President Clinton proposed steps to reduce such mistakes.The plan, which is designed to cut the number of errors in half by the year 2005, requires the Defense Department to set up a mandatory system for reporting medical mistakes, new rules to make drug packages easier to read and understand, and a research fund of $20 million to study errors and how to prevent them.Clinton also planned to ask states to require that healthcare institutions be required to report preventable errors that caused serious injuries or deaths, as well as the voluntary reporting of other mistakes and “close calls.” In doing so, he avoided a politically costly battle over a mandatory national reporting requirement.Data collected by the states would be analyzed and made public without naming the patients or healthcare professionals to educate people about the safety of healthcare systems across the country. Such reporting raises the issue of whether the data will be used to buttress malpractice claims. The White House called for legislation to protect the names of providers and patients as long it does not undermine the rights of individual patients to receive compensation for malpractice.The Clinton Administration is expected to take several specific steps. Within 1 year, the Food and Drug Administration must develop standards to help prevent errors caused by healthcare providers who confuse medications because of drug names that sound similar or packaging that looks similar, and it must write rules requiring the 3000 US blood banks and other institutions that handle blood to report serious errors. Clinton is also expected to ask the Federal Health Care Financing Administration to publish rules requiring the 6000 hospitals that take part in the federal Medicare program to create error reduction programs.The issue of medical errors has received considerable attention from healthcare organizations such as the American Medical Association, although that group opposes mandatory reporting rules because it fears malpractice fallout. US Senator Edward Kennedy (D-Massachusetts) said he will make acting on a bill to help reduce errors a priority this year.However, the issue of medical mistakes is not a new one, and the numbers cited in the IOM’s study merely mirror those of others that have gone before. However, concerns about legal liability and a lack of government support has kept legislative activity in the area to a minimum.The IOM’s highly publicized report, however, made officials and the public more aware of the problem and gave concrete suggestions on how to reduce the rate of errors. The IOM recommended the following: Establishing a National Center for Patient Safety to set safety goals, track progress, fund research on error rates and prevention strategies, and serve as a clearinghouse for educational information and best practices.Creating a mandatory, nationwide public reporting system that would hold institutions accountable for the rate of errors found within their walls. Currently, only about a third of states require such reporting.Voluntarily reporting near-misses and errors that did not have serious consequences and extending the cover of peer review to keep such reports out of the hands of malpractice attorneys and their clients.Increasing attention by licensing organizations to the issue of medical errors. Previous Back to top Next FiguresReferencesRelatedDetails March 7, 2000Vol 101, Issue 9 Advertisement Article InformationMetrics Copyright © 2000 by American Heart Associationhttps://doi.org/10.1161/01.CIR.101.9.e9015 Originally publishedMarch 7, 2000 Advertisement

MEDICAL ERRORS ARE THE FIFTH LEADING CAUSE OF DEATH IN THE United States and result in annual costs of up to $29 billion, according to estimates from the Institute of Medicine (IOM). These figures suggest that medical mistakes occur commonly in medical practice. Indeed, 95% of physicians surveyed reported witnessing a medical error, and 61% of health care professionals believe errors are a routine part of medical practice. Because medical errors have a large impact on patient care, it is important to consider the ethical issues regarding disclosure that arise when health care providers make or witness errors. According to the IOM report, many medical errors are due to systemic flaws rather than mistakes by particular health care providers. Examples of such systemic culprits include poor communication between multiple health care providers and inadequate labeling of drug interactions. Therefore, strategies that focus less on individuals’ actions and concentrate on systemic problems are more likely to detect and prevent medical errors. Such strategies include instituting electronic medical records and improving the coordination of patient care. A major challenge for hospitals in reducing errors is to institute systems that can better pinpoint, investigate, and prevent medical errors without exposing staff to excessive blame and litigation. When medical error is not disclosed, those who witness the error must determine whether they should remain silent or reveal the error. This decision can be particularly difficult for medical students, who must violate the traditional medical hierarchy to disclose the error. The doctrine of respondeat superior holds the attending physician ultimately responsible for all decisions concerning a patient. Does this doctrine relieve the medical student of any ethical responsibility to the patient? Entrants in the 2001 Conley Ethics Contest were asked to apply this question to the following scenario: “During your surgical clerkship, you observe a medical mistake during a procedure in the operating room. The error does not result in the patient’s death, but requires the patient to extend his stay in the hospital several days. In addition, the postoperative pain experienced by the patient is more significant than it would have been otherwise. The attending physician informs the patient that there was a complication during the procedure, but does not specify that it was secondary to his error. How do you respond?” In this issue of MSJAMA, the winning essays ultimately urge disclosure of the error by the physician and not by the medical student. Courtney Wusthoff discusses how the student should facilitate disclosure when the attending physician refuses to reveal the error. Scott Cowie and Susan Lee emphasize the importance of categorizing error by type and severity. Norman Fost adds a new perspective to this debate by examining ethical issues involved when a physician considers disclosing the error of another physician. Understanding these ethical issues will ultimately help reduce the occurrence of medical errors.

Medicolegal Sidebar: Legal Immunity for Healthcare Workers During COVID-19.

Letters Health AffairsVol. 20, No. 4: Consumers Vs. Managed Care Admitting Mistakes Is Not EnoughPhilip M. Stoffan AffiliationsParmenter O’Toole, P.C., Muskegon, MichiganPUBLISHED:July/August 2001No Accesshttps://doi.org/10.1377/hlthaff.20.4.258AboutSectionsView articleView Full TextView PDFPermissions ShareShare onFacebookTwitterLinked InRedditEmail ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions View articleTOPICSMedicinehealthaffHealth Aff (Millwood)Health AffairsHealth Aff0278-27151544-5208Project HOPE - The People-to-People Health Foundation, Inc.Calman Neil S.Institute for Urban Family Health, New York, New York72001Consumers Vs. Managed CareThe author responds:Philip Stoffan questions my suggestion of a reimbursement mechanism for patients injured by medical mistakes. He argues that it is more important to fix the problem than to stimulate litigation by disclosing the error. I agree. The question remains how to stimulate the necessary quality improvements without facilitating costly litigation.My suggestion of a reimbursement schedule for injured parties might help to accomplish this. Fear of repercussion including, but not limited to, fear of litigation is the most significant element in the shroud of secrecy over medical errors. If physicians knew that their errors would be reviewed by their peers with the objective of identifying corrective measures and that their patients would be compensated fairly without the involvement of attorneys, juries, and judges, they would be much more open to disclosing them and allowing us all to learn from their mistakes.Our systems seem to be moving in the opposite direction, however. A physician’s record of medical liability suits, whether settled or tried in court, lives on for years in the archives of state licensing authorities, in the credentials folders of hospitals and other health care providers, and now on the Web sites of some state health departments. The motivation to hide our errors is greater than ever.Jack Zusman points to the attempts of the Joint Commission to assure that medical errors are reported and reviewed honestly by the institutions they accredit. He does not reconcile the appalling rates of adverse consequences now openly being discussed in the professional and lay literature with the increasing emphasis on reporting and tracking recommended by the Joint Commission. The coexistence of these two phenomena underscores the failure of the JCAHO and state self-reporting systems to adequately identify medical errors that occur.Both letters highlight the complexity of the problem of disclosing medical errors and the essential nature of this disclosure in reducing their recurrence. The threat of litigation must be eliminated while offering patients who have suffered negligent care appropriate compensation. A nonpunitive environment must be created for the open discussion of other types of errors while tracking physicians to allow for the sanctioning of those who make repeated egregious errors. Patients have a right to know everything about their care, especially if they were adversely effected, if only to improve their ability to be more intelligent advocates for themselves in the future. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 1 July 2001 InformationCopyright 2001 by Project HOPE - The People-to-People Health Foundation, Inc.PDF download

Healthcare and medical advances have prolonged human life and thus have led to increasing numbers of elderly individuals. To make their lives more convenient, several ubiquitous technologies have been considered, including the RFID system, which can play a vital role in elderly care by caregivers as well as by elderly individuals themselves. Caregivers can take advantage of the RFID system by recording and tracking elderly individuals' belongings and assisting these individuals in healthcare provision by accessing their relevant information, among others. Similarly, the RFID system can help manage elderly individuals' daily lives by reminding them of their daily schedules (e.g., reminding them to take medicine on time) and tracking their personal belongings, among others. In addition, the RFID system can mitigate human errors such as medical mistakes, delays in service provision, and hassles in tracking and identifying patients and objects. This study provides a survey of solutions proposed in the literature and discusses the potential benefits of integrating the RFID system with sensors and applying the integrated system. In addition, the study addresses the opportunities, technological challenges, and research directions for the integrated RFID system in the context of smart solutions in elderly care facilities.

Resisting the adoption of medical artificial intelligence (AI), it is suggested that this opposition can be overcome by combining AI awareness, AI risks, and responsibility displacement. Through effective integration of public AI dangers and displacement of responsibility, some of these major concerns can be alleviated. The United Kingdom’s National Health Service has adopted the use of chatbots to provide medical advice, whereas heart disease diagnoses can be made by IBM’s Watson. This has the ability to improve healthcare by increasing accuracy, efficiency, and patient outcomes. The resistance may be due to concerns about losing jobs, anxieties about misdiagnosis or medical mistakes, and the consciousness of AI systems drifting more responsibility away from medical professionals. There is hesitancy among healthcare professionals and the general public about the deployment of AI, despite the fact that healthcare is being revolutionised by AI, its uses are pervasive. Participants’ awareness of AI in healthcare, AI risk, resistance to AI, responsibility displacement and ethical considerations were gathered through questionnaires. Descriptive statistics, chi-square tests and correlation analyses were used to establish the relationship between resistance and medical AI. The study’s objective seeks to collect data on primary and public AI awareness, perceptions of risk and feelings of displacement that the professionals have regarding medical AI. Some of these concerns can be resolved when AI awareness is effectively integrated and patients, healthcare providers, as well as the general public are well informed about AI’s potential advantages. Trust is built when, AI related issues such as bias, transparency, and data privacy are critically addressed. Another objective is to develop a seamless integration of risk management, communication and awareness of AI. Lastly to assess how this comprehensive approach has affected hospital settings’ ambitions to use medical AI. Fusing AI awareness, risk management, and effective communication can be used as a comprehensive strategy to address and promote the application of medical AI in hospital settings. An argument made by Chen et al. is that providing training in AI can improve adoption intentions while lowering complexity through the awareness of AI.

The Beat

A big part of making sure that patients get good care is making sure that healthcare management practices work. It is necessary for medical offices to use organised procedures because more and more people want fast healthcare delivery systems. This study looks at different ways to handle healthcare systems and what effects they have on the overall level of care for patients. The study uses both qualitative and quantitative methods to look at how standard operating procedures affect the health of patients, the speed of operations, and the happiness of healthcare providers. The goal of healthcare management guidelines is to make things easier, cut down on medical mistakes, and make it easier for teams from different fields to work together. The study looks into a few methods that are used in a lot of different healthcare situations, like hospitals, outpatient offices, and long-term care centres. The study looks at these practices using data from case studies, patient polls, and professional performance measures to find out what works and what doesn't when it comes to keeping a high level of care. The results show that guidelines that focus on patient-centered care, practices that are backed by evidence, and ongoing feedback loops make patients happier, cut down on treatment delays, and improve clinical outcomes. But problems with following the rules, a lack of resources, and differences in the experience of healthcare providers were named as things that can make them less successful. The study also shows how important it is to make procedures flexible so they can be changed to fit the needs of each patient. This way, personalised care can be provided without lowering the standard or efficiency of the healthcare system. This study has important effects for healthcare managers, policymakers, and doctors who want to improve patient care through better management. The results support the idea that healthcare management practices should always be changing. They also stress the need for flexible strategies that can change to the needs of modern healthcare systems.

Background and Aim: It is impossible to deny the threats and risks endangering the process of health care when offering the services. Confirming this fact does not mean ignorance the risk, or allowance to medical and nursing mistakes to happen; however, it can mean approaching the problem to come up with practical solutions and minimize the risks in the process of providing health care services. The present study was conducted periodically as an applied multi-stage research. Materials and Methods: To do a model of clinical risk management, different authentic texts on risk management in health sector were reviewed focusing on the models available. All such models were tabulated, analyzed and compared together which resulted 62 primary variables. The variables were, then, validated being used in a questionnaire responded by 20 nurses and doctors which, this time, produced a confirmed questionnaire of 40 variables. After that, 215 subjects chosen through a random and a stratified sampling were asked to respond to that questionnaire, making an exploratory factor analysis as well. Results: This study was done ,using principal components analysis as with a rotation of Varimax loadings showed a variety of factors (19 factors) available in the models of clinical risk management were loaded as organizing and policy-making factor. This factor illuminated a sum of 25.3% of variances in the model of clinical risk management. The results also showed the loading factor of variables as among 0.5 and 0.7 which indicated a fine correlation among them and the participants' view. Conclusion: It was concluded that the best care of the patient is accepted as a common perspective in organization and the effect of the treatment team's clinical performance on their financial payments are the most and the least important variables respectively with 0.739 and 0.548 as factor load.

Health Care Homicide? Or, Are Medical Errors Being Increasingly Criminalized?

Delphi Survey of Barriers and Organizational Factors Influencing Nurses' Participation in Patient Care Rounds

Errors are inherent in medicine due to the imperfectness of human nature. Health care providers may have a difficult time accepting their fallibility, acknowledging mistakes, and disclosing errors. Fear of litigation, shame, blame, and concern about reputation are just some of the barriers preventing physicians from being more candid with their patients, despite the supporting body of evidence that patients cite poor communication and lack of transparency as primary drivers to file a lawsuit in the wake of a medical complication. Proper error disclosure includes a timely explanation of what happened, who was involved, why the error occurred, and how it will be prevented in the future. Medical mistakes afford the opportunity for individuals and institutions to be candid about their weaknesses while improving patient care processes. When a physician takes the Hippocratic Oath they take on a tremendous sense of responsibility for the care of their patients, and often bear the burden of their mistakes in isolation. Physicians may struggle with guilt, shame, and a crisis of confidence, which may thwart efforts to identify areas for improvement that can lead to meaningful change. Coping strategies for providers include discussing the event with others, seeking professional counseling, and implementing quality improvement projects. Physicians and health care organizations need to find adaptive ways to deal with complications that will benefit patients, providers, and their institutions.

Health care benevolence laws, a form of tort reform law, mandate statements of sympathy or apology by health care providers and facilities in cases of medical mistakes. These laws create a shared language and sense of meaning for individuals involved in the legal aftermath of medical mistakes. Structuration theory guides this textual analysis to explore how benevolence laws discursively create and structure shared meaning about apology. This analysis highlights how benevolence laws structure apology and discursively discipline medical practitioners, underscoring the importance of ambiguity in law interpretation.