What this paper is about is…A plea to take the electronic health record…and look at it as a tool, a lens, through which to study and assess overall safety….
— Dr. Don Berwick, founder of the Institute for Healthcare Improvement
and a founder of the modern patient safety and quality movement

Protected Real-time Patient Safety Triggers & Analytics
To Improve the Safety & Reliability of Care

Pascal Metrics has pioneered the use of real-time triggers from electronic health records (EHR), electronic medical records (EMR), and from other health IT to support patient safety and quality improvement, as well as providing a new timely data stream to empower more proactive, responsive risk management.

Building on the Global Trigger Tool (GTT), Pascal has taken members of its Community Collaborative far beyond simply automating triggers — including GTT triggers but expanding well beyond.  Pascal has designed, developed, and deployed a comprehensive, systematic, and value-oriented management system to drive clinical, financial, and regulatory value.

Pascal’s collaborative of leading health systems has demonstrated and continues to show that the use of real-time EHR triggers and analytics to measure, monitor, and manage all-cause harm not only improves safety and quality but fundamentally provides the systematic rich and deep understanding of care otherwise unavailable.

Finally, this is where the field is headed.  As recently published in the Annals of Internal Medicine by Dr. David Classen, Fran Griffin, and Dr. Donald Berwick in the article, “Measuring Patient Safety in Real Time:  An Essential Method for Effectively Improving the Safety of Care,” the co-authors point out that:

“Surveillance for harm in the electronic record using the leading commercial EHR vendors’ products can be affordable, sustainable, and actionable….Building on what has been learned from the use of triggers in the past 15 years and leveraging the EHR is a reliable approach to measuring all causes of harm in all hospitalized patients, with minimal resources and in a time frame that allows for concurrent mitigation and prevention.”

Welcome to the next generation of real-time patient safety and quality improvement!

Our Solutions

Across the United States and around the world, Pascal serves leading health organizations in developing a “cultures of safety,” eliminating harm using real-time patient safety solutions, and enabling clients to learn more about their care with a pioneering “lens” using real-time EHR data.  And, wherever possible, we bring to bear a wide community of learning.

Learn about our patient safety solutions →

Our Services

The services that underlie our solutions rely on one of the largest and most valuable patient safety data sets available, scientifically validated and clinically robust methodologies, and an advanced and highly scalable technology platform.  Thanks to working with leading healthcare organizations, we prize the opportunity to learn continuously and to enable our entire community of clients to benefit.

Learn about our real-time PSO-protected services →

The Opportunity

The opportunity achieved by successfully implementing real-time patient safety is three-fold:

Clinical.  Both peer reviewed published research and real-world evidence substantiates that the prevalence of harm is very high, affecting one out of every three patients in U.S. hospitals according to a landmark Health Affairs article.  Another  landmark article in the British Medical Journal estimates that up to 440,000 patients lose their lives each year due to harm, making it the third leading cause of death in the United States.  As patients engage more in their care and have access to more information and tools, it’s imperative that caregivers are likewise empowered with the capability to systematically find and eliminate patient harm.

Financial The magnitude of the cost of harm has been validated by peer reviewed published research to be $33-$63 billion in the United States; more important for financial validation and investment, leading health systems in the Pascal-convened Community Collaborative have demonstrated that a large health system has a financial opportunity equal to hundreds of millions of U.S. dollars.  Pascal estimates at least US$2 million per 10k admissions per year of financial opportunity related to excessive length of stay alone, even when considering only 14 top harm categories in the inpatient setting alone.

Regulatory.  Finally, regulators in the United States, with likely other regulators to follow globally, have announced publicly their intention to replace the current coding/claims approach to safety-based reimbursement to one based on EHR data.  Given that Pascal and its Community Collaborative of leading health systems has operationalized a method and system for doing so at scale, and given that it has contributed to the very evidence that the regulators are consulting, Pascal is well positioned and stands ready to prepare, support, and assist health systems making the transition.

Learn how Pascal’s real-time PSO supports value-based patient safety →

Implementation Considerations

A real-time Patient Safety Organization (PSO) is the optimal vehicle for finding and reducing harm for the following reasons:

Clinical.  Deploying the Global Trigger Tool (GTT) or other trigger-based detection methods inevitably identify very high levels of harm, typically in excess of 10 times the level of the industry standard, voluntary event reporting.  Automating a trigger-based method and doing so within a non-punitive PSO-protected “culture of safety” are critical for achieving clinical effectiveness.

Data.  Relying on multiple EHR-agnostic sources of data that go well beyond event reporting, coding/claims, and traditional data is essential for success.  More importantly, take advantage of a standardized, normalized data to enable “apples-to-apples” comparisons.

Technical.  Ideally a single cloud-based library of triggers & analytics enabled by multi-tenancy, i.e., one instance of the software in the cloud being used across all users, allows for superior analytic innovation to due faster rapid cycles of improvement. Building on an event-driven architecture using advanced technologies such as complex event processing is optimal.

Analytic.  Much of healthcare, but especially within patient safety, performs analysis retrospectively. Instead, a comprehensive approach should address the entire temporal analytic continuum: retrospective (archeological), concurrent (deliberative), and prospective (predictive) analytics.

Operational.  Operating with a “control tower” metaphor, bring data together in a clinically relevant and useful patient safety event management workflow that is EHR-agnostic and conducive to innovation, making data available to relevant users and pushing data as needed.

Regulatory.  Understand where the regulators are headed, using the peer-reviewed published evidence as clues.  Align with regulator direction, which has embraced the use of EHR data to measure safety and relying on PSOs as vehicles for implementing safety requirements, including in the recent 21st Century Cures Act.

Scientific.  Given the state of the art in defining patient harm and where the regulators are headed in measuring safety, ensure that safety outcomes data being used to develop predictive and other advanced analytics use similar definitions – otherwise placing at risk substantial analytic investment.

Financial.  Generate financial ROI for doing the above work, amplifying the effect the more risk is being borne for patient outcomes.  Indeed, the CFO-grade business case for patient safety has never been stronger, and tap into expertise to translate improvements in safety and reliability into margin expansion.

Learn more about Risk Trigger®, which anchors the Pascal real-time PSO and a foundational service for driving value

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