November 14, 2011

To Err is Human – And We Keep Doing It

(Ivanhoe Newswire) -- As many as one million Americans may have died from adverse events in U.S. hospitals over the past decade, the IOM (Institute of Medicine) estimates. Electronic Health Records may hold the key to patient-safety, according to an article published online November 9 in the New England Journal of Medicine (NEJM).

"Simply providing better-quality EHR-derived safety data to physicians and hospitals can have a profound effect on patient-safety activities throughout the country," authors said.

Since the release of To Err is Human, a famous report by the IOM, a series of initiatives were launched across the country in an attempt to make health care safer.

Now, three studies have called into question whether the U.S. has made any progress at all. The first, Landrigan et al., found that rates of injury due to medical error had remained essentially unchanged between 2000 and 2008 at 10 North Carolina hospitals.

The second, a report from the Inspector General of the Department of Health and Human Services (DHHS) revealed that Medicare patients experienced substantial harm in U.S. hospitals as recently as 2008.

In the third, David C. Classen, M.D. and colleagues found that almost one in three patients are harmed during their hospital stay; and that traditional approaches to measuring adverse events substantially underestimate their frequency.

"If the United States has made any progress in patient safety, it has been inadequate," authors Ashish K. Jha, M.D., M.P.H., and Classen wrote.

The primary reason for insufficient progress is the lack of a robust measurement system, according to the article, but what does this mean?

There are still no nationally universal methods for identifying, tracking and reporting adverse events. Furthermore, in the few areas of patient safety that have seen improvement (e.g., catheter-related bloodstream infections), the changes are due, in part, to measurement programs run by the Centers for Disease Control and Prevention. In other areas, with inadequate measures, patients continue to suffer from the consequences of unsafe care, authors said.

Although some patient-safety metrics are in use, they tend to be very poor-quality. The best known among these are patient-safety indicators, which use billing data to identify potential complications during hospitalization. Data is collected after the fact, failing to engage clinicians at the time of care delivery. The data collected are also not available to providers for review until years after the care was provided.

So, are there any effective measurement systems for patient-safety?

"Despite these challenges we currently have an opportunity to turn the tide," authors wrote. "EHRs can systematically measure patient safety, turning a laborious, manually intensive, and expensive process of sifting through medical records to identify adverse events into an automated one that is efficient, consistent, and affordable."

Electronic health records are already an integral part of the health care system, but most are not built with this capability in mind. However, the technology is available. It would be very expensive and difficult to retrofit EHR systems already in use with the technology, so EHR vendors must commit to building new systems with it already in place.

EHRs can improve the safety and culture of U.S. health care, but only if the federal government demonstrates that it is serious about improving patient safety. Without these data, authors wrote, the nation is likely to continue seeing good intentions, a lot of effort, and little progress or benefit.

The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 provides financial incentives for physicians and hospitals to become 'meaningful users' of electronic health records.

The federal government could include the ability to measure and report adverse event rates as a core requirement of meaningful use, eligible for financial incentives. If done, it would expedite the process of vendors including the capability in every EHR sold in the U.S.

"The U.S. health care system is at a crossroads when it comes to ensuring patient safety and earning the trust of the public. Our inadequate progress since To Err is Human is disheartening, but we have an opportunity to right the ship," authors wrote.

SOURCE: NEJM, published online November 9, 2011