From the President ... Mary Logan
March 28, 2013
On Avalanches, Medical Devices, the EHR, and Lipstick
Much of my time in the first quarter of 2013 has been focused in the human factors space. Perhaps I’m simply obsessed and thus see it everywhere I turn. More likely, it’s a constant drumbeat in the field from the increasing intolerance to complexity and technology overload. Do you hear it, too?
AAMI just published a monograph from last summer’s Nuclear Power-Healthcare Workshop, Risk and Reliability in Healthcare and Nuclear Power: Learning from Each Other. One of the four areas of focus in this unique collaboration with the Idaho National Laboratory was human factors, which is covered in Chapter 6.
To the weary clinician in the field, the attention given to human factors must seem like lipstick, an afterthought that comes at the end of a process. Pockets of the healthcare community are pushing back and asking for more than a lipstick approach.
The Office of the National Coordinator has acknowledged that usability must have a greater focus in the health information technology space. My stroll through the exhibit floor at the recent HIMSS conference affirmed that need. A week later, an article in Health Leaders summarized the dizziness and frustration of clinicians as they find an increasing amount of their “patient care” time spent communicating with an electronic health record (EHR) system that doesn’t recognize, understand, or seemingly care about their needs as caregivers. My own physician is so frustrated that he simply dumps his load of handwritten notes from each 15-minute patient visit on his nurse, who has to enter them into the EHR at the end of a long day with 30-40 patients.
Earlier this month, AAMI was a sponsor at the Human Factors and Ergonomics Society’s conference on healthcare, with three days of sessions led by human factors experts. It was followed by a workshop hosted by AAMI and led by its outstanding human factors faculty. An “aha” moment was Dr. Matt Weinger showing film clips of Vanderbilt’s usability testing (simulation) that is guiding medical device purchasing decisions before a particular device has been selected.
The U.S. Food and Drug Administration’s (FDA) new guidance on home healthcare devices contains an important human factors theme that reflects the growing emphasis by the Center for Devices and Radiological Health on the importance of making technology easier, more intuitive and less prone to human error. In short, we’re talking about making technology safer.
And yet, we can’t put the entire human factors burden on device manufacturers and EHR vendors. Healthcare delivery organizations need to do more as well. Weinger’s use of simulation at Vanderbilt and Johns Hopkins’ use of a human factors expert inside the clinical engineering department illustrate best practices that others would do well to emulate.
Consider this all from another perspective. Out on the slopes, clinical engineer and back country skier Steve Hamill took a three-day course in January on how to survive in avalanche terrain. The focus of the course, as detailed in an Associated Press story, was how to use human factors to help people make better decisions. There were sessions on team communication; the importance of slowing down to analyze the situation; and the use of a communication checklist modeled after those used by airline pilots. For example:
- Has the group agreed to respect everyone’s voice?
- Is there anything wrong with the trip plan?
- Would another route option be better?
- Can team members see and hear each other?
- Is there an escape plan/route?
Hamill no doubt learned tips that he can apply in his day job as a clinical engineer.
The AAMI 2013 Conference & Expo is offering a two-part Human Factors 101 course. It should be on everyone’s “must attend” list, a great opportunity for healthcare technology management professionals to learn how to apply human factors to their day jobs. AAMI also offers an array of industry-focused human factors courses on a regular basis.
Being a fabulous design, safety, or clinical engineer does not equate with being a human factors expert. And much like enrolling in a course on how to survive an avalanche, taking the time to understand human factors is going to slow you down at first. But you can either slow down on the front end or pay the much more painful consequences of slowing down on the back end, when a product doesn’t make it through the FDA approval process, isn’t purchased by a hospital, sits on a shelf unused by clinicians, is entangled in adverse incidents or recalls, or worse. All of us whose hands touch technology in healthcare have an obligation to make human factors a priority, up front. The return on investment works for everyone: less wasted healthcare dollars; improved customer satisfaction; fewer clinician complaints and calls; and more efficiently managed healthcare; and the holy grail—safer patients.
Sincerely,
Mary Logan, JD, CAE
AAMI President
mlogan@aami.org
+1-703-253-8265