Risk Trigger® Monitoring Subscription:
EHR Trigger-based Safety Management

The Risk Trigger® Monitoring Subscription is Pascal’s flagship software service enabling the measurement, monitoring, and management of all-cause harm, each “clinical trigger” (or “EHR trigger”) firing on real-time data streaming into Pascal’s Patient Safety Organization (PSO)-protected cloud from the electronic health record (EHR) and other health IT systems.

EHR Trigger based safety management


These EHR triggers — initially based on automating the Global Trigger Tool (GTT) but moving well beyond — have been configured by Pascal’s expert clinical team to operate successfully in the most widely tested and clinically effective patient safety event management workflow existing in the field today.

Many leading health systems amongst Pascal’s client community have adopted the field’s first cloud-based patient safety system using real-time EHR triggers. Clinical teams using this longitudinal all-cause harm management system are enabled to answer questions such as the following:

  • Where is patient harm happening and how frequently?
  • What is the severity and pattern of the harm?
  • Why is this harm happening, and how can it be avoided?

Whether by a standalone hospital or a health system with dozens of facilities, Risk Trigger® Monitoring is relied upon to deliver analytics in order to support programs in patient safety, quality improvement, and risk management.  Illustrative analytics include:

  • Patient Safety Dashboard — visual display of summary metrics being tracked by a healthcare organization
  • Adverse Event Analytics — visual display of more detailed reporting and analytics along dimensions such as severity, location, cost, and timeframe
  • Enterprise Analytics — visual display of enterprise-level and grade reporting and analytics across units and facilities, ad hoc reporting, and more


Detect & Reduce Harm

Pascal clients identify 10 times the level of harm that is identified by voluntary event / incident reporting systems.  Besides having more visibility into patient-specific harm, as well as the patterns of harm, clients have demonstrated the reduction of over 30% of the harm identified.

Manage Safety & Reliability

Many clients have shared that, upon starting work with Pascal, their safety leaders saw using EHR triggers to measure harm as the precipitating factor.  However, upon seeing the power of all-cause harm “lens,” multiple clients have reported Risk Trigger® providing more insight into their care delivery than any other system they have.

Reduce Harm-related Cost  

Data from Pascal’s National Collaborative for Patient Safety Automation and Improvement shows over US$2 million of harm-related financial opportunity per year per 10,000 admissions, even when considering only excessive length of stay (XLOS), 14 top harm types, and the inpatient setting only.  Clients are demonstrating the ability to realize over 30% of this US$2 million per year per 10,000 admissions financial opportunity.

Preserve “Culture of Safety

Unfortunately, even high performing health systems committed to patient safety find their environments risky, and identifying harm for the purpose of “getting to zero” in a spirit of improvement requires a non-punitive “culture of safety.”  Pascal was the first federally certified Patient Safety Organization (PSO) using real-time data to be fully audited and offers federal PSO protections to its clients — thereby, preserving a “culture of safety” to support the delivery of safe and reliable care.

How It Works

Highlights of the process to enable clinical teams include:

Real-time EHR Data Streaming

Based on a foundation of evidence-based EHR triggers, Pascal’s client health systems stream real-time data (e.g. HL7)  from EHRs/EMRs and other health IT into Pascal’s real-time analytics cloud-based infrastructure called our Patient Real-time Interoperable Metrics Engine (PRIME).

Real-time Triggers & Analytics Firing

As patient data streams into the PSO-protected Pascal PRIME, our multi-tenant Pascal Analytics Library fires triggers and analytics against that real-time streaming data to identify patients who may have been harmed, who may currently be suffering from harm, or may be at risk of harm.

Epidemiologically Sound Clinical Review

Due to Pascal’s unwavering commitment to evidence-based medicine and sound epidemiology, “gold standard” clinical review is used to generate clinically confirmed adverse events, populating the largest clinically confirmed safety outcomes data set using EHR data known.

Intervention, Concurrent / Real-time

Supporting real-time or concurrent intervention while a patient is receiving care is a core function of Risk Trigger® but not the only function.  Using both clinically confirmed adverse events as well as other safety information in the patient safety event management system, action is taken based on the data by unit-level, intervention coordinator, and rapid-response teams.

Improvement, Rapid-Cycle

Supporting rapid-cycle improvement — measured in hours or days versus weeks or months — is also a core function of Risk Trigger®.  Because EHR trigger-based detection is able to identify patterns of harm more quickly than alternative and conventional methods, this valuable information can be fed into highly rapid-cycle quality improvement work to improve outcomes more efficiently and more effectively.

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