So much for the critics who doubted the feasibility that as many as 98,000 deaths were caused each year by medical errors, as claimed in the 1999 Institute of Medicine's "To Err is Human." Now, nearly seven years later, the recent announcement of the success of the Institute for Healthcare Improvement's (IHI) "100,000 Lives Campaign" claiming between 115,000 and 149,000 saved lives in 18 months suggests that the 1999 estimate wasn't so far off after all. If anything, it underestimated the number.
But the achievement is also remarkable for the interest and support demonstrated by the more than 3,000 hospitals that have enrolled in the quality initiative since December 2004, when IHI President Donald Berwick, M.D., challenged healthcare leaders to improve quality through the campaign.
This group, which accounts for about three quarters of the acute care beds in the United States, pledged to implement six evidence-based and life-saving interventions. In addition, more than 50 healthcare organizations — including state hospital associates and quality improvement organizations and 90 national professional organizations — stepped up to leadership roles at state and regional levels.
Although the IHI's intercessions are clinically focused and target direct-care practices, they all rely upon the dissemination and adoption of evidence-based best practices and on communication between caregivers. And one — which cites the goal to "prevent medication errors by ensuring that accurate and continually updated lists of patients' medications are reviewed and reconciled during their hospital stay, particularly at transition points" — has electronic medical record (EMR) functionality written all over it. Hospitals which committed to this goal so far number 2,185.
How many of these, I wonder, credit technology tools with their improved performance? And what percentage of the hospitals in this group are using EMRs?
It would be expected that the nation's leading provider organizations — which have been aggressive in adopting clinical automation tools, including electronic medical records (EMRs) — are part of this group, but certainly many are not.
There is broad endorsement of the goal, as set by the current administration, that every American have an electronic health record by 2014. Among the nation's provider organizations, most executives say that they either have or are developing EMR implementation strategies. Most name quality and safety as the key drivers.
With core functionalities including clinical-decision support, computer-based provider order entry and e-prescribing, EMRs are often perceived as the missing link between care and quality and safety. Like other powerful software tools, EMRs expand the capabilities of users, empowering them to provide better patient care through access to both patient data and best-practice information and more effective communication.
But EMR use in less-capable hands is quite another story. At its worst, an EMR can be disruptive, invasive and downright dangerous. Stories of deaths and near-deaths attributed to newly installed systems are not unheard of, particularly in the early post-implementation days. Although the system usually takes the rap, the real culprit is human error.
Making a wrong selection within a computer program can be just as easy and just as fast as making a right one. Who hasn't mistakenly deleted a very important document from their computer despite the automated query, 'Do you really want to delete this?'
Simply adding automation without assessing existing workflow and incorporating necessary changes, adequately training all users and implementing an oversight and feedback mechanism will do little or nothing to improve efficiency and quality. If anything, it raises risk factors.
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