Health IT and Patient Safety Building Safer Systems for Better Care (2012) / Chapter Skim
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2 Evaluating the Current State of Patient Safety and Health IT
2 Evaluating the Current State of Patient Safety and Health IT
Pages 31-58
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From page 31... ...
In fact, health IT can be a contributing factor to adverse events, such as the overdosing of patients because of poor user interface design, failing to detect life threatening illnesses because of unclear information displays, and delays in treatment because of the loss of data. Adverse events, such as these, have lead to serious injuries and death (Aleccia, 2011; Associated Press, 2009; Graham and Dizikes, 2011; Schulte and Schwartz, 2010; Silver and Hamill, 2011; U.S.
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system with computerized provider order entry (CPOE) in Pittsburgh and Seattle.
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From page 33... ...
Next, it describes how policy makers can learn from health IT experiences from abroad. COMPLEXITY OF HEALTH IT AND PATIENT SAFETY In general, health IT is not a specific product but is composed of components -- such as computerized provider order entry (CPOE)
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From page 34... ...
These products were consistently correlated with lowering the frequency of medication errors and may be able to reduce preventable adverse drug events significantly (Kaushal et al., 2003; Shamliyan et al., 2008; Wolfstadt et al., 2008)
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From page 35... ...
Studies with generic descriptions of health IT products and patient safety issues will be of little utility to users because health IT products -- even those made by the same manufacturers -- are heterogeneous, tailored to individual clinical settings, and have varying impacts on patient safety. Therefore, to assist users in selecting the safest health IT product for their unique clinical environment, studies need to be able to name specific health IT products, describe how those products have been implemented, and identify their impact on patient safety in different clinical environments.
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From page 36... ...
Users and researchers need to be encouraged to provide specific descriptions of safety problems associated with particular health IT products in order to provide potential users with credible data regarding which IT products are safer than others. BARRIERS TO KNOWING THE MAGNITUDE OF THE HARM When researchers, consumer groups, and users attempt to identify and share information on health IT features related to adverse events and patient safety risks, they can be faced with barriers created by market inefficiencies within health IT, such as lack of information available to consumers and the inability of users to freely move between health IT products.
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From page 37... ...
Regardless of whether these barriers have actually been used to prevent reporting, the fear of legal action itself may prevent health professionals from sharing crucial health IT–related information with researchers, consumer groups, other users, and the government. As stated by the American Medical Informatics Association, such clauses should be considered unethical (Goodman et al., 2011)
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From page 38... ...
, electronic prescribing (e.g., computerized provider order entry) , results reporting and management (e.g., clinical data repository)
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From page 39... ...
. Potential Benefits Safety Concerns – Large increases in legible orders – Increases relative risk of medication errors – Shorter order turnaround times – Increased ordering time – Lower relative risk of medication errors – New opportunities for errors, such as: – Higher percentage of patients who at • fragmented displays preventing tain their treatment goals a coherent view of patients' medications • inflexible ordering formats generating wrong orders • separations in functions that facilitate double dosing • incompatible orders – Disruptions in workflow Clinical Decision Support (CDS)
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From page 40... ...
Potential Benefits Safety Concerns – Significant reductions in relative risk – Introduction of workarounds; for of medication errors associated with: example, clinicians can: • transcription • scan medications and patient • dispensing identification without visually • administration errors checking to see if the medication, dosing, and patient identification are correct • attach patient identification bar-codes to another object instead of the patient • scan orders and medications of multiple patients at once instead of doing it each time the medica tion is dispensed Patient Engagement Tools Tools such as patient portals, smartphone applications, email, and interactive kiosks, which enable patients to participate in their health care treatment. Potential Benefits Safety Concerns – Reduction in hospitalization rates – Reliability of data entered by: in children • patients, • families, – Increases in patients' knowledge • friends, or of treatment and illnesses • unauthorized users NOTE: Table 2-1 is not intended to be an exhaustive list of all potential benefits and safety concerns associated with health IT.
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From page 41... ...
Clinical Decision Support CDS systems are also an important component of an EHR. They can monitor patient conditions, prescriptions, and treatment to provide evidence-based clinical suggestions to health professionals at the point of
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From page 42... ...
The majority of systematic reviews in this area report that most studies have demonstrated positive impacts on patient safety by improving practitioner performance and reducing the relative risk of medication errors, time to therapeutic stabilization, and risk of toxic drug levels (Ammenwerth et al., 2008; Conroy et al., 2007; Durieux et al., 2008; Garg et al., 2005; Georgiou et al., 2007)
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From page 43... ...
. In addition to monitoring for potential medication errors, CDS systems can also suggest potential diagnoses and treatment, monitor patients' conditions, determine whether a potential or actual adverse event may occur, and alert clinicians to potential adverse conditions.
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From page 44... ...
Bar-Coding The introduction of a bar-coding system to administer medication and verify patient identification has been strongly associated with significant reductions in relative risk of medication errors, including transcription, dispensing, and administration errors (Franklin et al., 2007; Poon et al., 2010)
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From page 45... ...
. Despite the presence of these workarounds, the overall effect of bar-coding has been shown to substantially reduce the relative risk of medication errors, both at the point of care (Franklin et al., 2007; Poon et al., 2010)
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From page 46... ...
LEVERAGING EHR DATA TO IMPROVE SAFETY OF POPULATIONS In addition to results reporting for individual patients, EHRs can be a rich source of data for the identification of care gaps and patient lists for monitoring and clinical action across populations. While the degree of harm to patients is unclear, the failure to follow up on laboratory results represents one of the leading causes of lawsuits in the outpatient setting (Gandhi et al., 2006)
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From page 47... ...
Initially, automated EHRs were used to detect adverse drug events in hospital patients (Classen et al., 1991; Jha et al., 1998)
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From page 48... ...
. Although it focuses on a broad range of safety issues, "Action Area 8: Technology and Patient Safety," most specifically, targets systemic and technical aspects to improve patient safety around the world by promoting personal health records (PHRs)
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From page 49... ...
CONCLUSION Health IT has already been shown to improve medication safety. Although the evidence is mixed for areas outside of medication safety, both within the United States and abroad, the fact that several studies have improved patient safety with implementation of health IT leads the committee to believe that health IT has at least the potential to drastically improve patient safety in other areas of care.
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2008. The effect of electronic prescribing on medication errors and adverse drug events: A systematic review.
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2010. The impact of computerized provider order entry on medication errors in a multispecialty group practice.
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2007. The utility of adding retrospective medication profiling to computerized provider order entry in an ambulatory care population.
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2003. Effects of computerized physician order entry and clinical decision support systems on medication safety: A systematic review.
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2009. The impact of computerized provider order entry systems on inpatient clinical workflow: A literature review.
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From page 55... ...
A systematic review. Journal of the American Medical Informatics Association 16(5)
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From page 56... ...
Review of the evidence of the impact of computerized physician order entry system on medication errors. Health Services Research 43(1 Pt 1)
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From page 57... ...
2008. The effect of computerized physician order entry with clinical decision support on the rates of adverse drug events: A systematic review.
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