MedStar’s Human Factors Center: An Interview with Dr. Raj Ratwani

Posted on January 10, 2018 I Written By

When Carl Bergman isn't rooting for the Washington Nationals or searching for a Steeler bar, he’s Managing Partner of EHRSelector.com.For the last dozen years, he’s concentrated on EHR consulting and writing. He spent the 80s and 90s as an itinerant project manager doing his small part for the dot com bubble. Prior to that, Bergman served a ten year stretch in the District of Columbia government as a policy and fiscal analyst, a role he recently repeated for a Council member.

Background: Recently, I had a wide ranging interview with Dr. Raj Ratwani, Acting Center Director and Scientific Director of MedStar Health’s National Center for Human Factors in Healthcare.

The center is MedStar’s patient safety, and usability applied research arm. MedStar is the Mid Atlantic area’s largest medical facility non profit operating 10 major hospitals as well as dozens of urgent care, rehab and medical groups.

MedStar set up the center, as part of its Institute for Innovation five years ago. The Institute is an in house service of several centers that conduct research, analysis, development and education. In addition to human factors, the Institute turns MedStar staff’s ideas into commercial products, conducts professional education, encourages healthy lifestyles and develops in house software products.

The Human Factors Center’s work concentrates on medical devices, as well as creating new processes and procedures. The center’s 30 person staff features physicians, nurses, engineers, product designers, patient safety, usability and human factors specialists. The Center’s focus is on both MedStar and on improving the nation’s healthcare system with grants and contracts from AHRQ, ONC, CMS, etc., as well as many device manufacturers.

Dr. Ratwani: Dr. Ratwani’s publications are extensive and were one reason prompting my interview. I met with him in his office in the old Intelsat building along with Rachel Wynn the center’s post doctoral fellow. We covered several topics from the center’s purpose to ONC’s Meaningful Use (MU) program to the center’s examination of adverse event reporting systems.

Center’s Purpose: I started by asking him what he considered the center’s main focus? He sees the center’s mission as helping those who deliver services by reducing their distractions and errors and working more productively. He said that while the center examines software systems, devices take up the lion’s share of its time from a usability perspective.

The center works on these issues in several ways. Sometimes they just observe how users carry out a task. Other times, they may use specialized equipment such as eye tracking systems. Regardless, their aim is to aid users to reduce errors and increase accuracy. He noted how distractions can cause errors even when a user is doing something familiar. If a distraction occurs in the middle of a task, the user can forget they’ve already done a step and will needlessly repeat it. This not only takes time, but can also lead to cascading errors.

Impact: I asked him how they work with the various medical centers and asked about their track record. Being in house, he said, they have the advantage of formal ties to MedStar’s clinicians. However, he said their successes were a mixed bag. Even when there is no doubt about a change’s efficacy, its acceptance can depend on a variety of budget, logistic and personal factors.

EHR Certification: I then turned to the center’s studies of ONC’s MU vendor product certification. Under his direction, the center sent a team to eleven major EHR vendors to examine how they did their testing. Though they interviewed vendor staffs, they were unable to see testing. Within that constraint, they still found great variability in vendor’s approach. That is, even though ONC allowed vendors to choose their own definition of user centered design, vendors often strayed even from these self defined standards.

MU Program: I then asked his opinion of the MU program. He said he thought that the $40 billion spent drove EHR adoption for financial not clinical reasons. He would have preferred a more careful approach. The MU1 and MU2 programs weren’t evidence based. The program’s criteria needed more pilot and clinical studies and that interoperability and usability should have been more prominent.

Adverse Events: Our conversation then turned to the center’s approach to adverse events, that is instances involving patient safety. Ratwani is proud of a change he helped implement in Medstar’s process. Many institutions take a blame game approach to them berating and shaming those involved. MedStar treats them as teaching moments. The object is to determine root causes and how to implement change. Taking a no fault approach promotes open, candid discussions without staff fearing repercussions.

I finally asked him about his studies applying natural language processing to adverse patient safety reports. His publications in this area analyze the free text sections of adverse reporting systems. He told me they often found major themes in the report texts that the systems didn’t note. As a follow on, he described their project to manage and present the text from these systems. He explained that even though these systems capture free text, the text is so voluminous that users have a difficult time putting them to use.

My thanks to Dr. Ratwani and his staff for arranging the interview and their patience in explaining their work.
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A word about DC’s old Intelsat building that houses the Institute. Normally, I wouldn’t comment on an office building. If you’ve seen one, etc., etc. Not so here. Built in the 1980s, it’s an example of futurist or as I prefer to call it Sci-Fi architecture and then some. The building has 14 interconnected “pods” with a façade meant to look like, well, a gargantuan satellite.

Intelsat Building

 

To reach an office, you go down long, open walkways suspended above an atrium. It’s all other unworldly. You wouldn’t be terribly surprised if Princess Leia rounded a corner. It’s not on the usual tourist routes and you can’t just walk in, but if you can wangle it, it’s worth a visit.

Intelsat Building Interior