Policy Points: Improving Patient Safety
(cont.)
Electronic records
The Institute of Medicine issued a
follow-up to its “To Err is Human” report,
emphasizing the importance of having comprehensive electronic
record and computer systems to support patient safety programs.
(The report, “Patient Safety: Achieving a New
Standard for Care” (2003) is available on line at: www.iom.edu/report.asp?id=16663) The systems would
have many applications, including:
• Storing and sharing patient records in
standardized formats;
• Entry of prescriptions with less chance
for error in interpretation and use of computer
programs to double-check the suitability of the prescription for the particular patient;
programs to double-check the suitability of the prescription for the particular patient;
• Recording and analyzing adverse events;
• Computer-assisted diagnosis and chronic
care management to improve clinical
decision-making and compliance with guidelines;
decision-making and compliance with guidelines;
• Tracking and responding to infectious
disease outbreaks; and
• Using telemedicine to allow critically
ill patients in small rural hospitals to be monitored
around-the-clock by physicians with advance training in intensive care.
around-the-clock by physicians with advance training in intensive care.
The goal, the
institute said, is to establish “a system that both
prevents errors and learns from them when they occur.”
The institute also favors prompt nationwide implementation of a
unique health identifier for each patient for the exchange of
patient-specific information in order to avoid
“fragmentation of patient data [that] can lead to medical
errors and adverse events.”
Slow physician response
Physicians, as a group, have been slower
to adopt quality improvement programs and measures of
performance than health-care institutions. A study of
physicians by Anne-Marie Audet and her colleagues reported that
fewer than half of physicians involved in direct patient care
could very easily or somewhat easily use their current medical
record system to list patients by diagnosis or age group (44
and 49 percent, respectively). A lower proportion of physicians
could very easily or somewhat easily list patients by
medications the patients were taking (about 16 percent), and
approximately 40 percent of physicians said such data could not
be generated with their current system. (Health Affairs, 24, no. 3 (2005):
843-53). Tracking of medications that patients are taking is
especially important for patients taking high-risk medications.
Only one-third of
physicians reported receiving any data about the quality of
care they provided, and most of that data was from patient
surveys. Generally, physicians in larger groups, particularly
with 50 or more physicians, were more likely to receive
quality-of-care information. Physicians in larger groups also
were more likely to be involved in systematic activities to
improve quality of care.
Involvement of
physicians in quality improvement activities is likely to
increase. A trend in medical specialty programs is to require
recertification, and part of the recertification process is
increased emphasis on quality improvement programs.
A step forward and a step back
The 1999 report “To Err is
Human” set a goal of a reduction of medical errors by 50
percent over five years. A comprehensive study has not
documented whether that goal has been met, although experts who
study the health-care system doubt that it has.
The president of the Joint
Commission, Dennis O’Leary, MD, testified before Congress
this year that, “Much progress has been made in improving
patient safety since the IOM issued its report . . . but we may
actually be falling further behind as new drugs, procedures,
and technologies are introduced every day. Each of these has
inherent safety risks that have not been identified, and they
are usually introduced into care delivery settings where
patient safety and systems thinking are not constantly top of
mind.” g
Jeff Atkinson teaches
courses in health-care law and policy at DePaul University
College of Law in Chicago, where he graduated summa cum laude.
He writes on legal, medical, and ethical issues.
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