META-ANALYSIS OF CONTINUOUS IMPROVEMENT EFFICACY: VERSUS PAPER AND COMPARATIVE EMRS

4^th International Conference on Medical Informatics & Telehealth

October 6-7, 2016 | London, UK

Steven H. Shaha

Center for Public Policy & Administration, USA

Posters & Accepted Abstracts: J Health Med Informat

Abstract :

Introduction: Since the IOMâ�?�?s â�?�?To Err Is Humanâ�?, and other indicting publications, continuous improvement methodologies have become commonplace throughout healthcare. Quantified successes include improvements in clinical outcomes, efficiency, satisfactions and cost-per-case. Also noteworthy, proliferation near-ubiquity of EMRs, promising improved outcomes beyond codecapture and info-storage alone. However, all EMR vendors have not provided rigorous proof of EMRs enabling impactful continuous improvement beyond paper-alone, or comparatively versus other EMR designs. Are there EMR characteristics for comparatively greater continuous improvement capabilities? Methods: Meta-analysis included 16 matched organisations: Four for three contrasting EMR designs/approaches, four paperbased non-EMR. Data included 6-month pre-EMR baselines versus 24-month post-implementation. All organizations leveraged interchangeable high-value methodologies (6-Sigma, Lean). Catheter associated urinary tract infections (CAUTIs) represented the only undertaking universal in the 16. One statistician with SPSS and SAS did all analyses. Results & Interpretations: Comparative gains versus baselines (each p<0.001): â�?¢ Non-EMR achieved 5.3% improvement by 6-months, 8.2% by 24. â�?¢ Compliance-focused, non-programmable EMRs: 4.9% 6-months, 29.1% 24, plateauing by 20-months. â�?¢ Somewhat-programmable EMRs: 17.2% 6-months, 56.4% 24, no plateauing. â�?¢ Locally programmable/adaptable EMR: 29% 6-months, 87.2% 24, no limitations for improvement thereafter: no plateauing. Conclusions & Discussion: EMRs are superior to paper-based alone for continuous improvement. EMR characteristics determine the magnitude and speed of continuous improvement, as well as apparent long term limitations (i.e. plateauing). Some EMRs resulted in 10-times the improvement versus other EMRs, and never plateaued. Key EMR characteristics determine efficacy and magnitude of continuous improvements. Review of those characteristics is crucial to considering optimal design and capabilities for healthcare organizations.

Biography :

Email: steve.shaha@att.net