Medical mistakes are the third leading cause of patient deaths in the United States of America; numbering approximately 450,000 deaths in 2016 at a cost of $1.44T or 45% of the total annual cost of healthcare. The root cause of medical mistakes is cognitive overload; which is caused by too much information and too little time to acquire, analyze, apply and adapt it. An information technology (IT) information management solution could provide the error-free cognitive support needed to improve decision-making, maximize care cost-effectiveness, mitigate medical mistakes, optimize case outcomes and accelerate knowledge accrual.

The Cloud Healthcare Appliance Real-Time Solution as a Service (CHARTSaaS)© is such a solution: an Internet cloud-based IT software development environment (SDE) intended for use by healthcare providers subject matter experts (SMEs) to create mobile applications or “apps” that:
• access the SDE whenever needed for a low and variable monthly subscription cost based on system resource usage;
• design, develop, deploy, operate and optimize artifacts (processes, cases, rules/decisions, analytics and interoperability) and apps using an Internet-connected Windows® device;
• install and operate apps using any iOS® or Android® mobile device;
• use apps they have designed whenever/wherever needed to acquire, assess, apply and adapt Internet-accessible digital information;
• optimize efficiency and effectiveness of problematic use cases such as differential diagnosis, treatment planning and failure to rescue;
• review archived artifact operations and optimize as needed; and
• derive new knowledge for application to future cases.

Hand-off communication (HoC), the error-prone transition of care and patient-specific information from one healthcare professional to another, serves as a CHARTSaaS proof of concept. A fatal example of a HoC was reported to The Joint Commission as follows: “A health care system submitted a root cause analysis (RCA) to The Joint Commission for a sentinel event that involved a patient whose blood levels were not drawn frequently enough to monitor the thinness of her blood while receiving a continuous heparin infusion. The patient had been started on a heparin infusion on an orthopedic unit and then was later transferred to a cardiac unit. The order set for the heparin infusion was not entered properly, leaving out the automatic order for blood tests every 6 hours. During the handoff report, the nurses did not discuss when the next blood test would occur to monitor the heparin infusion. For 24 hours, the patient went without blood tests until an oncoming nurse questioned the situation during the handoff report. At this time, the off-going nurse also reported that the patient had been complaining of a headache for several hours. A computerized tomography (CT) scan showed intracerebral hemorrhage. When the patient’s mental status deteriorated, the family chose not to proceed with surgery due to the patient’s multiple comorbidities and recent decrease in quality of life. She expired three days later.”

This HoC episode is diagrammed in Illustration #1. An analogous episode with a CHARTSaaS-built mobile app running is diagrammed in Illustration #2. The screens for the app are diagrammed in Illustration #3. For this case,