Survey of Medical Informatics

1. Survey of Medical Informatics CS 493 – Fall 2004 November 8, 2004 V. “Juggy” Jagannathan

2. Quality Improvement and Proactive Hazard Analysis Models: Deciphering a New Tower of Babel Appendix F: Patient Safety - Achieving a New Standard of Care. IOM Report

3. Quality improvement • Two category of tools – page 473 table • Continuous quality improvement, six sigma and Toyota production system • Proactive hazard analysis tools – healthcare failure mode and effect analysis • Shewhart and Deming analytical approaches

4. Tools brief • Table D-1 pg 474 • Table D-2 pg 476

5. Commonalities between the approaches • Each tool is a scientific and statistical analytical approach to analyzing a process • Scientific • Decision driven by data • Process focus • Improvement focus • Prevention focus • Team approach

6. Common elements for QI tools • Customer focus • Waste reduction • Empowerment • Reducing errors to near zero • Focus on control • Organizational

7. Features of PHA tools • Hazard score matrix • Regulatory oversight – FDA • Identification of critical process steps • International standard • Attempts to look broadly to identify hazards • Attempts to identify rare multi-failure cases • Fault trees and risk assessment • Assignment of specific probabilities

8. IOM recommendation – establish a clearinghouse for process and methodological related information for healthcare

9. Hazard Analysis approach • Identify high-risk process • Create a process flowchart • Assess implementation of process • Assess variability of implementation and failure modes • Assess effects of failures • Root cause analysis of critical possible failures • Redesign process to eliminate/reduce failures • Recursive analysis of the overall redesigned process • Evaluate process using simulation • Evaluate process using pilots • Identify and collect performance measures • Monitor and implement a process of continuous improvement

10. Data requirements • Error taxonomy • Impact • Type • Domain • cause

11. Case Studies