New security standards for electronic data

Hospitals soon will be required to comply with new security standards that have been proposed by the Department of Health and Human Services. The new standards are meant to protect patients' medical records from improper access, alteration, or loss when they are maintained or transmitted electronically. All facilities that transmit or maintain electronic health information will need to develop a security plan, provide training for employees, and secure physical access to records. The proposed regulations include technical guidance as well as administrative requirements. See http://www.hhs.gov/cgi-bin/waisgate?WAISdocID=451574590+0+0+0&WAISaction=retrieve on the Internet for more information.

This month’s spotlight features rural 80-bed, Kewanee (IL) Hospital. Our source is Nancy E. Richman, PhD, quality manager.

o Problem

Kewanee’s emergency department (ED) set door-to-drug target for administration of the clot dissolver t-PA for myocardial infarction (MI) to 30 minutes.

Phase I target: Interdisciplinary team, "Heart Breakers," analyzed timing and process for three intervals:

1. door-to-patient-data;

2. data-to-treatment-decision process;

3. decision-to-drug.

o Quick fix

Revised standing orders for MI treatment; re-introduced the "clot box" for quick access to needed supplies.

Three-month results: Average door-to-drug cycle times dropped from 60 to 32 minutes.

Phase II target: Reduce what Richman dubs "huge variation" within the door-to-drug times. Match national benchmark of 30-minutes at least 95% of the time.

o Solution

In progress, develop cardiac care pathway to standardize the diagnostic and treatment process. Expand continuum of care for AMI: Early diagnosis during emergency medical technician (EMT) transport, through increased use of Kewanee’s already strong cardiac rehab and smoking cessation program. Identify variables that contribute to the variation — patient/family cooperation, diagnostic clarity, and emergency staff availability. Explore expandable staffing using a code signaling cross-trained nurses to help in the ED.

o Early Phase II results

EMTs administer aspirin and use MI checklist to alert ED when heart attack patient is en route.

o Keys to success

There is interdisciplinary participation using clear QI methodology (focus-plan-do-check-act).

o Contact

For more information on this month’s Grass-roots QI, contact Nancy E. Richman, PhD, Kewanee Hospital, 719 Elliott St., Kewanee, IL 61443. Telephone: (309) 852-6413. E-mail: [email protected].