Remediate the Problem

Prioritization and planning are necessary for effectively remediating your current EHR-related problems; extra care should be taken to ensure that corrective actions do not lead to other adverse unintended consequences.

Question 1: How do you identify and prioritize corrective actions?

It's one thing to conduct the causal analysis, it's another to figure out when and how problems should be addressed. Corrective actions necessary to remediate EHR-related unintended consequences will vary across organizations; however corrective actions are likely to fall into one or more of the following broad categories:

  1. Software Change
  2. Training for Local IT Staff
  3. Training for End Users
  4. Configuration Change
  5. Custom Programming
  6. Care Process Change
  7. Policy Change

Corrective actions should directly address the root causes outlined in the causal statements. Table 4.1 in the next section of Module IV provides a summary of causal statements accompanied by corrective actions for an illustrative case. In the toolbox below we provide a link to a template that will allow you to keep track of your own causal statements and corrective actions.

In addition, consider the following factors as you prioritize corrective actions for unintended consequences.

Who is affected by the unintended consequence(s)?

  • Clinicians
  • Patients
  • IT Staff
  • Administrators
  • Others (e.g., regulators, payers)
  • All or some of the above

What issues does the unintended consequence create for them?

  • Safety issue
  • Quality issue
  • Performance/productivity issue
  • Financial issue
  • Accounting issue
  • Compliance/regulatory/legal issue

What types of activities or units are affected?

  • Clinical
  • IT
  • Billing
  • Ancillary services
  • Facilities

What downstream processes are affected?

  • Orders (ancillary services, medications, laboratory, radiology, referrals)
  • Results (medication refills, laboratory, radiology, consults)
  • Scheduling
  • Billing/accounting
  • Compliance reporting

How extensive are the effects?

  • Limited — effects limited to a specific instance or specific activity
  • Widespread — has recurring effects or affects several activities or entire departments
  • Extremely widespread — affects many activities or departments

How serious are the effects?

  • Not very
  • Somewhat
  • Serious
  • Very serious

How urgent is remediation?

  • Not very
  • Somewhat
  • Urgent
  • Very urgent

Question 2: How do you develop a plan to remediate unintended consequences?

The earlier sections have primarily focused on identifying and understanding the root causes of unintended consequences. We have provided tools to help you identify corrective actions. However, these tools provide only high-level guidance for remediating unintended consequences.

Just as you need a careful plan for implementing an EHR, you should carefully plan any change in policy, processes, or technology designed to addresses an EHR-related problem. In this section we provide a tool you can use to develop a detailed plan for remediating unintended consequences.

Useful Tool

Develop a Detailed Remediation Plan: The following template is adapted from the remediation planning process used at Kaiser Permanente of Colorado. This document is designed to help health care organizations of all types and sizes develop detailed plans for remediating unintended consequences. Download the remediation planning process plan

The next section of Module IV focuses on how to track the remediation process.