In "Patient Safety: Achieving A New Standard For Care," the group recommends that Congress authorize the Department of Health and Human Services to lead and fund a public-private partnership to develop and promote data standards. The report also recommends the development of a government database that collects data in aggregate from health providers about medical errors and near misses.
In a 1998 report, the institute estimated that tens of thousands of patients in the United States die or are adversely effected by medical errors. Technologies such as electronic health records and bedside drug bar-code systems that can alert doctors to patient drug allergies and other factors can help prevent those mistakes. The new report also advocates improved collection of data about medical errors.
Health and Human Services "should establish a national database that collects anonymous patient information that can be used to develop new interventions to prevent errors and improve safety," said Dr. Paul Tang, chief medical information officer at the Palo Alto Medical Foundation in Palo Alto, Calif., and chair of the institute's Committee on Data Standards for Patient Safety, in a public briefing about the report. That database would also require a standardized reporting format and uniform terminology to be effective, he added.
In recent months, Health and Human Services has endorsed various data-messaging and other standards to help facilitate the sharing of clinical information within government health related agencies, especially at the Centers for Medicare and Medicaid, the nation's largest payer of health care. The Institute of Medicine report recommends that further development of those standards be accelerated.
So far, the government's adoption of standards hasn't translated into a mandate for private health-care companies to adopt those standards. "The IOM nor the government thinks mandating standards and IT is the direction to go," says Edward Hammond, a professor of community and family health at Duke University and a contributor to the report, which was in development for about a year.
In lieu of government mandates, the institute is proposing that the federal government create financial incentives to get doctors and others to invest in and use IT such as electronic health records. For instance, doctors or hospitals that have adopted minimum systems and met certain criteria, such as deploying electronic health records, embracing specific data standards, and meeting certain care-performance measurements, might be reimbursed by Medicare at a rate higher than those doctors who don't meet those standards. Such pilots between the government and health-care providers are under way, Hammond says.
Rod Piechowski, program manager for patient safety and electronic health records at the National Alliance of Health Information Technology, says the new report "is mirroring what we think should be done" in terms of the adoption of electronic health records and standards that can allow the sharing of clinical information among multiple health providers.
Paul Clayton, chief medical information officer at Intermountain Healthcare, which operates 21 hospitals in Utah, says his company has been using electronic health records for 30 years and reduced drug costs at one hospital by $600,000 in one year through use of electronic drug alerts to pharmacy systems that surgical patients no longer needed preventative antibiotics.