Safety, Technology, Anger And Hope
America's patient safety record is a source of embarrassment that angers both clinicians and patients. The right IT tools can help mitigate the danger to life and limb.
Consider these statistics:
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--U.S. healthcare providers make about 1 million medication errors each year.
--Roughly 50,000 to 100,000 deaths occur annually in the U.S. from adverse drug reactions.
--Up to one in four patients in the U.S. are harmed at some point in their lifetimes by a variety of medical mistakes.
--Doctors perform operations on the wrong body part as often as 40 times a week.
Several medical thought leaders are working on ways to improve these stats with various new operational and cultural approaches, but let's not ignore what technology can accomplish.
The Office of the National Coordinator for Health Information Technology must have had some of these abysmal figures in mind when it launched the Reporting Patient Safety Events Challenge. The intent of the challenge was to help encourage reporting of adverse reactions and to modernize the paper-based system for reporting these events, ONC's Adam Wong told InformationWeek Healthcare. That paper approach is responsible for too few reports being submitted, Wong says, but also "inaccurate reports due to errors in transcription. It's also less secure, since reports are transmitted by fax rather than a secure communication system."
KBCoreSM, a software platform that collects clinical data and analyzes safety reports, won the competition -- held in April through August of 2012, with winners announced November 14 -- making it easier for stakeholders to submit reports and for patient safety organizations to obtain meaningful insights from the reports themselves.
[ Is it time to re-engineer your clinical decision support system? See 10 Innovative Clinical Decision Support Programs. ]
The software integrates with an electronic health record -- and other device and medication databases, such as scanned barcodes worn on patient wristbands -- to extract data. KBCoreSM uses an HL7 interface to gather relevant information, and users can submit either a fully identified or anonymous report while knowing the platform provides secure communications between professionals and organizations.
Hopefully, software like this will let providers get a better handle on medication errors. But even before KBCoreSM came along, there were useful tools available to address the nation's patient safety shortcomings.
The New England Healthcare Institute, a nonprofit health policy institute, has been doing its part. A NEHI report emphasizes the value of currently available but underutilized IT tools such as computerized physician order entry. It rightly refers to CPOE as "a revolutionary computer application designed to intercept errors where they usually occur -- at the time medications and diagnostic tests are ordered. Not only does CPOE automate the order-writing function, it also incorporates clinical decision support during the order-entry process."
Despite CPOE's potential to improve patient safety, U.S. hospitals have been dragging their feet on implementation. As of the third quarter of this year, 35% of U.S. hospitals had a CPOE system, according to HIMSS Analytics -- in other words, almost two-thirds of our hospitals have yet to take advantage of the technology.
Of course, price is a barrier for many hospitals. The most recent cost analysis from NEHI and the Massachusetts Technology Collaborative, performed in 2008, found that the onetime average total cost of a CPOE system is $2.1 million, with an annual increment in operating costs of $435,000. However, the report estimated that a CPOE that includes robust clinical decision support could reduce adverse drug reactions and unnecessary drug and laboratory test use, generating an annual savings to each hospital of $2.7 million. Drug and lab test costs drop when physicians have easy access to cost-effective prescribing guidelines and alerts available in a well-planned CPOE/clinical decision support system.
Of course, like all other technologic advances, CPOE systems -- and the EHRs they inhabit -- have their downside. Data transmission errors do occur in these systems. Dean Sitting and Hardeep Singh from the University of Texas and Baylor College of Medicine, respectively, point out that it's not uncommon for data transmission tables to have mismatched data fields. Such errors, for example, could cause an order for 30 mg of oxycodone, sustained release, to be mapped to 30 mg, immediate release, resulting in a patient receiving the wrong formulation.
Most healthcare stakeholders would agree, however, that the benefits of information technology outweigh the risks. There's certainly reason to be hopeful.
Clinical, patient engagement, and consumer apps promise to re-energize healthcare. Also in the new, all-digital Mobile Power issue of InformationWeek Healthcare: Comparative effectiveness research taps the IT toolbox to compare treatments to determine which ones are most effective. (Free registration required.)