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Common Formats and the Network of Patient Safety Databases. Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality Presented to the ONC HIT Policy Committee – Safety Task Force 13 June 2014. Reducing Patient Safety Events.
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Common Formatsand theNetwork of Patient Safety Databases Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality Presented to the ONC HIT Policy Committee – Safety Task Force 13 June 2014
Reducing Patient Safety Events • Creating a culture of safety – the Patient Safety Organization (PSO) Program • Providing standard definitions & reporting formats to harmonize reporting – the Common Formats • Providing specific information on HIT-related adverse events – the Formats device module • Aggregating nationwide safety information at the Network of Patient Safety Databases
Common Formats • Common language for patient safety event reporting • Common language & definitions • Standardized rules for data collection • Standardized patient safety reports (“apples to apples”) • Authorized by statute; developed through a formal, collaborative process
Common Formats • Only national patient safety reporting scheme designed to meet all of the following four goals: • Support local quality/safety improvement • Provide information on harm from all causes • Allow comparisons over time & among different providers • Allow the end user to collect information once & supply it to whoever needs it (harmonization) – a long-term goal • Designed to decrease data collection burden!
Network of Patient Safety Databases • Patient Safety Act authorized creation of PSOs, which in turn report aggregate patient safety data to a Network of Patient Safety Databases • The NPSD is designed to provide an interactive evidence-based management resource for providers, patient safety organizations, & other entities – a national resource for quality improvement & research • There are certain rules governing confidentiality of data that must be followed
HIT-Related Adverse Events • In 2010, AHRQ, FDA, & ONC collaborated to develop a special, enhanced module to the Common Formats to address HIT-related adverse events • Experience with PSOs & others suggests that: • Many HIT-related adverse events present as other types of patient safety events, e.g., medication errors • HIT usually plays an indirect role, as a contributing factor
Collaborating to Learn • It is important to view HIT’s contribution to patient risk in the context of “all cause harm” • It is also valuable to have available a focus of professional knowledge regarding the special, complex nature of HIT risk • For these reasons, ONC – with its Patient Safety Center – AHRQ – with its PSOs & NPSD – make an ideal partnership for expanding understanding of HIT risk & how to reduce it across the nation
Common Formats on the Web https://www.psoppc.org