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IT's Role in Improving Patient Safety—Where Do We Stand?

May 10, 2016
by Rajiv Leventhal
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In 1999, an Institute of Medicine (IOM) report “To Err is Human: Building a Safer Health System” brought about an awareness about medical errors in healthcare organizations that had not previously existed. The report was based upon analysis of multiple studies by a variety of organizations and concluded with the shocking figure that between 44,000 to 98,000 people die each year as a result of preventable medical errors.

Since the release of that report, the push for improved patient safety has continued across the healthcare ecosystem. But just last week, a study by researchers at Johns Hopkins Medicine, reported on by National Public Radio (NPR) online, revealed that medical errors rank as the third-leading cause of death in the U.S., and highlights how shortcomings in tracking vital statistics may hinder research and keep the problem out of the public eye, as reported in a news story by Healthcare Informatics Editor-in-Chief Mark Hagland. The study was published an article The BMJ (formerly the British Medical Journal).

Per Hagland’s report, the NPR article notes that, “Based on an analysis of prior research, the Johns Hopkins study estimates that more than 250,000 Americans die each year from medical errors. On the CDC's official list, that would rank just behind heart disease and cancer, which each took about 600,000 lives in 2014, and in front of respiratory disease, which caused about 150,000 deaths,” for an estimated average of 400,000 deaths a year. “

What’s more, The BMJ article itself mentions the aforementioned report, per Halgand: “The most commonly cited estimate of annual deaths from medical error in the U.S.—a 1999 IOM report—is limited and outdated. The report describes an incidence of 44,000-98,000 deaths annually. This conclusion was not based on primary research conducted by the institute but on the 1984 Harvard Medical Practice Study and the 1992 Utah and Colorado Study. But as early as 1993, Leape, a chief investigator in the 1984 Harvard study, published an article arguing that the study’s estimate was too low, contending that 78 percent rather than 51 percent of the 180,000 iatrogenic deaths were preventable (some argue that all iatrogenic deaths are preventable). This higher incidence (about 140,400 deaths due to error) has been supported by subsequent studies which suggest that the 1999 IOM report underestimates the magnitude of the problem.”

As such, various health IT leaders point to the role that technology such as electronic health records (EHRs) can play in preventing medical errors. James Merlino, M.D., president at South Bend, Ind.-based clinical improvement software company Press Ganey, and former chief experience officer and associate chief of staff at the Cleveland Clinic, for instance, says “Every month you’re seeing evidence that [technology] decreases medical errors and thus improves safety. Merlino, who is a former clinician himself, feels that organizations do a good job in teaching providers how to use EHRs, but are not great in figuring out how to best integrate them into their workflows. “When they can integrate it into their workflows, it’s not only a good tool for providing additional capabilities, but it helps them deliver higher quality and safer care,” Merlino says.

James Merlino, M.D.

Merlino says what strikes him about the BMJ study, and what should scare all patients, is indeed that the 1999 IOM report “underestimated the severity of the problem.” He says, “Stepping back from the technology aspect, organizations need to make safety a non-comprisable core value. You can be the best surgeon operating at the greatest health center in the world, but if you make a safety error and kill a patient, what’s the point?”

Human Problem or Tech Problem?

Paul Dexter, M.D., research scientist, Regenstrief Institute, Inc., and chief medical information officer (CMIO) of Indianapolis-based Eskenazi Health, feels that because clinicians have not grown too comfortable with their use of EHRs still, providers have not been able to optimize the best ways to use IT to decrease medical errors. “We still have user-friendliness issues to work out. Clinicians are not terribly satisfied with these EHRs. We have a long evolution to go yet,” Dexter says.

Nonetheless, Dexter points out that while humans are imperfect, they have a certain rate of making errors, for example, diagnostic errors, as it’s estimated that 10 percent of initial diagnoses are wrong, due to biases and the like. “But that’s not to say that by far the vast majority of clinicians are well-intentioned, well-meaning, focused, and hard working,” he says. “The focus needs to be on the work environment in which they are working.”

Paul Dexter, M.D.