Jason Adelman: A Career Shaped by Systemic Issues

Director of New Patient Safety Science Center Seeks to Improve Systems to Prevent Medical Errors

Photos by Rudy Diaz

Jason Adelman, MD, didn’t start his medical career thinking he would become a leader in patient safety and quality. After completing an internal medicine residency, he initially followed in his family’s tech-driven footsteps by starting a medical software company.

Recruited to a New York City hospital with the provision that he could work on the hospital’s health IT system, Dr. Adelman improved patient safety through use of the electronic health record. A new role as patient safety officer, which included implementing the Joint Commission’s first National Patient Safety Goals, led to a career in patient safety research. He recalls an incident in the hospital in which a woman was accidentally given a dose of methadone that was intended for another patient. “It would have been easy to blame the health care providers involved, but blaming them would not prevent this type of error from happening again,” Dr. Adelman said in an interview for the Joint Commission Journal on Quality and Patient Safety. “A foundational principle of patient safety is to identify system failures that lead to errors and fix the systems.” He worked with a team of clinicians, patient safety leaders, and health IT experts to build two alerts that were shown in a randomized trial to significantly reduce wrong-patient errors.

“Health care delivery is complex and any number of things along the care delivery continuum can go wrong,” Dr. Adelman says. “The best chance we have to prevent errors is to simultaneously leverage technology, improve clinical decision support, reduce clinician burden, and improve the systems that facilitate these dynamics.”

No Quick Fixes

Jason Adelman, center, with Benjamin L. Ranard, deputy director of the Center for Patient Safety Science, left, and Maureen Kelly, director of quality and patient safety in the Department of Medicine

Dr. Adelman has developed a sequential approach that has defined his work in patient safety operations and research: Identify errors, follow up with clinicians soon after errors are made to understand how the errors occurred, create an intervention to prevent the error from happening again, and conduct randomized controlled trials to evaluate effectiveness of the intervention.

“I often see the drive to solve a problem right now. But without taking time to understand the problem and the contributions of different elements of the system, you may not know exactly what you are trying to fix and whether the solution works as intended. Ultimately, it is better to invest time and effort putting in place a sound strategy—create and validate reliable process and outcome measures, rigorously test interventions, and monitor the outcomes—and thereby generate evidence to actually fix the problem. What we learn benefits our patients and can also be shared widely with other health systems facing these common challenges,” says Dr. Adelman.

Joining Columbia in 2015 as a hospitalist, Dr. Adelman is now associate dean for quality and patient safety at VP&S, director of the new Center for Patient Safety Science, vice chair for quality and patient safety in the Department of Medicine, and system associate chief quality officer for patient safety and learning health system science for NewYork-Presbyterian. Research by Dr. Adelman and colleagues has appeared in high-impact journals including JAMA, JAMA Internal Medicine, and JAMA Pediatrics.

Research Findings Lead to National Guidance

Dr. Adelman’s work in patient safety research includes development of the Wrong-Patient Retract-and-Reorder (RAR) Measure, a validated and reliable method of quantifying the frequency of wrong-patient orders placed in electronic ordering systems. The Wrong-Patient RAR Measure was the first automated measure of medical errors and the first health IT safety measure endorsed by the National Quality Forum. The method identifies thousands of near-miss wrong-patient errors per year in large health systems, enabling researchers to test interventions to prevent this type of error.

Wrong-Patient RAR has been used to evaluate the effectiveness of patient safety interventions in multiple studies conducted in diverse EHR systems and clinical settings, including in the neonatal intensive care unit. Research is underway to extend the RAR methodology to specific types of medication errors such as wrong-dose and wrong-drug errors and to develop other new health IT safety measures.

Dr. Adelman’s research findings have led to national patient safety guidance, including a 2016 recommendation issued by the Office of the National Coordinator for Health Information Technology that health care organizations use the Wrong-Patient RAR Measure to monitor the frequency of wrong-patient orders. Another pivotal regulation addressed the non-distinct naming conventions used by most hospitals for newborns, e.g., Baby Boy Jones or Baby Girl Jackson. As of 2019, the Joint Commission requires hospitals to adopt distinct methods of newborn identification based on results of a study led by Dr. Adelman. In that study, simply using a more distinct naming convention that incorporated the mother’s first name significantly reduced wrong-patient orders in the neonatal intensive care unit by 36%.

Developing the Next Generation of Patient Safety Researchers

Dr. Adelman has been PI on numerous grants to study quality and patient safety by leveraging health IT and informatics to improve health care delivery and outcomes. He leads the EQUIP Center for Learning Health System Science, which was awarded $5 million this year by the Agency for Healthcare Research and Quality and is a collaboration among Columbia University Irving Medical Center, Weill Cornell Medicine, NewYork-Presbyterian, Albert Einstein College of Medicine, and Montefiore Medical Center.

EQUIP leadership across the five organizations will direct the creation of new models of learning health system infrastructure to develop a cadre of diverse researchers who generate evidence that leads to rapid and broad improvements in health equity and outcomes. EQUIP will award pilot funding for faculty to conduct a total of 12 learning health system projects over five years that focus on the intersection of health equity and quality/patient safety. This includes opportunities to receive research education, mentorship, support, and experience to prepare faculty to successfully complete research projects and apply for future extramural funding. “I want to use every opportunity to promote the value of a high-functioning learning health system to improve quality, patient safety, and patient outcomes,” says Dr. Adelman.

Center for Patient Safety Science Ushers in a New Era for Advancement

VP&S has established the Center for Patient Safety Science, or CPSS, to formalize Columbia’s commitment to patient safety and quality and to demonstrate national leadership in this field. The center is led by Jason Adelman, MD, a leading expert and innovator in patient safety measures and research who has received top honors for developing novel methods embedded in health IT systems to measure and prevent errors and whose research has informed national recommendations and regulations with direct applications to health policy and patient care.

Creation of CPSS recognizes patient safety as a fundamental principle of health care delivery and the need to generate pioneering work across research, education, and practice to reduce the occurrence of avoidable harm and drive equitable, consistent, and sustainable improvements across the medical center. It expands on the former Center for Patient Safety Research founded by Dr. Adelman in 2017, which published groundbreaking studies and trained physicians to become researchers in this field.

"Since 2017, Dr. Adelman has created a seminal body of work,” says VP&S Dean Katrina Armstrong, MD, “and this center will build upon it, bringing together cutting-edge programs in research, education, and implementation to ensure that Columbia becomes a national leader in patient safety.”

CPSS will provide a formal pathway for faculty from multiple departments and divisions to collaborate on patient safety research. A quality and patient safety training academy will encourage medical students, house staff, and faculty to pursue careers in this field. To directly impact patient care, the center will work with ColumbiaDoctors, the faculty practice, to use predictive models and innovative interventions to prevent adverse patient safety events. A stakeholder advisory board will engage the community in setting patient safety priorities and developing research projects. The center’s activities also will be guided by an external advisory board that will provide periodic external review of key ColumbiaDoctors safety programs.

More information: https://www.vagelos.columbia.edu/CPSS

As director of the established Patient Safety and Health Services Research Fellowship, a T32 training funded by the Agency for Healthcare Research and Quality, Dr. Adelman mentors postdoctoral fellows in projects addressing many challenges facing patients today. Launched in 2018, the fellowship trained eight physicians in its first five years, 63% of whom were women and 38% of whom were from underrepresented minority groups. Five of the eight graduates have joined the Columbia faculty, one has joined Weill Cornell, four have received continued grant funding, two are seeking K awards in patient safety research, and two received honors in pediatric research. The fellowship has been renewed for 2023 to 2028 to train an additional 15 physician researchers. Dr. Adelman’s dedication to mentorship and commitment to advancing patient safety in critical areas earned him both the John M. Eisenberg Excellence in Mentorship Award from the Agency for Healthcare Research and Quality and the John M. Eisenberg Patient Safety and Quality Award for Individual Lifetime Achievement from the Joint Commission.

“We need to develop the next generation of leaders and researchers to work on solving the difficult quality and safety challenges in health care,” says Dr. Adelman. “This overall approach aligns with our ongoing efforts to become an effective learning health system; that is, a system that leverages the vast repository of EHR clinical and log data to generate evidence that can be readily translated into improving care.”

Further, he adds, support for patient safety means understanding that it is often not productive to blame health care providers for medical errors. “Humans make errors and we must make preventing errors a mission and a priority, then devote time, energy, and resources to that goal.”

Priorities for the New Center

Among Dr. Adelman’s research priorities is understanding the unintended consequences of AI and the potential for harm from AI tools. “I believe AI will improve patient care and patient safety, but we must be smart, use good judgment, and evaluate AI interventions before blindly implementing them.”

Columbia’s leadership in patient safety will include the creation of a High-Reliability Computerized Provider Order Entry system that operates without serious error or failure. “Building on the utility of the Wrong-Patient RAR Measure, my research team has developed and validated several additional measures of order errors in two different EHR systems by applying the RAR methodology,” says Dr. Adelman. “We are in the process of developing a program that can run these measures against a simple file of order data generated by any hospital or health system. The program can be easily distributed and can be used by staff with limited time and technical resources. The result will allow many hospitals to judge how they rank among peers and identify opportunities for error-reducing interventions.”

Dr. Adelman credits VP&S Dean Katrina Armstrong for making patient safety a core value and a priority and putting resources toward the new Center for Patient Safety Science. At NewYork-Presbyterian, Steven J. Corwin, MD, president and CEO, and Deepa Kumaraiah, MD, senior vice president and chief medical officer, have supported Dr. Adelman’s efforts to foster a culture that makes patient safety a priority.

3 Key Goals of the Center for Patient Safety Science

Conduct multiple, high-impact, innovative patient safety research projects

Recruit and train high-impact patient safety researchers to create the knowledge to advance patient safety
Partner with the Department of Biomedical Informatics, the Data Science Institute, and external collaborators, including the New York State Department of Health, to increase the rigor and impact of patient safety research
Fund pilot projects to create collaborative research across Columbia University, leveraging strengths in computer science, statistics, industrial engineering, and operations research
Provide core support for patient safety research
Evaluate the implementation of innovative AI and genomic programs

Create robust internal and external educational and training programs

Create an internal quality and patient safety training academy
Develop a standard curriculum for Columbia faculty, nurses, medical assistants, house staff, and students
Engage with medical students, house staff, and faculty to foster their interest in patient safety and connect them to patient safety projects
Advance the center’s findings through publications, news media, national conferences, patient advocacy groups, and symposia, building Columbia’s reputation as a leader in patient safety research
Present an annual National Patient Safety Excellence and Innovation Award

Improve patient safety across the medical center

Provide support to design, implement, and evaluate patient safety projects based on the most common trends and challenges in patient safety
Encourage alignment of faculty patient safety research endeavors with leading patient safety priorities
Advise chief medical officer and chief quality officer on best practices in quality and safety to guide improvement efforts in all locations, departments, and services
Support the implementation and analysis of an annual safety culture survey
Advise on implementation of predictive models to prevent adverse patient safety events

Spring/Summer 2024