The extent and cost in human lives of medical errors—and how health information technology can make a dent in the problem—remains difficult to determine. But most experts in the industry confirm that it remains a vexing problem that’s becoming more difficult to solve as treatment and delivery increase in complexity.
The newest study to assess the degree of medical errors, recently published in the British Medical Journal, comes from Johns Hopkins University School of Medicine, which estimated that more than 251,000 people die annually from medical errors in U.S. hospitals. That would make it the third leading cause of death in the U.S., exceeded only by heart disease and cancer.
Healthcare information technology is but one tool that can be used to address medical errors that have serious consequences for patients, experts note, through the use of technology such as clinical decision support and bar-coding. However, IT also can contribute to medical errors, often the result of human error, workflow issues, communication challenges and other issues. HIT further has been cited as causing patient safety concerns, most recently by the ECRI Institute.
The Johns Hopkins study is an attempt to provide updated metrics on the extent of the problem. It notes that a commonly referenced study on medical errors, the pivotal 1999 Institute of Medicine report “is limited and outdated.” That study, which estimated medical errors caused 44,000 to 98,000 deaths annually, was based upon a 1984 Harvard Medical Practice Study and a 1992 study in Utah and Colorado.
Despite the prominence and frequent reference of the IOM report, subsequent research has suggested that the IOM report “underestimates the magnitude of the problem.” The Johns Hopkins study bases its estimates on four more recent studies, conducted from 2000 to 2008. Those studies extrapolate results to estimate a range of medical error-caused deaths from 135,000 to 400,000 annually.
“We calculated a mean rate of death from medical error of 251,454 a year using the studies reported since the 1999 IOM report and extrapolating to the total number of US hospital admissions in 2013,” the authors write in explaining their methodology.
Many causes of medical error exist, and one of the main contentions of the study’s authors is that further study of life-threatening errors is hampered by a lack of data on medical errors as causes of death. Death certificates, authors note, ask for a cause of death, but only seek to know the medical disease to which a death is attributed, and not whether a medical error caused or abetted a patient’s demise.
“We believe this understates the true incidence of death due to medical error because the studies cited rely on errors extractable in documented health records and include only inpatient deaths,” they write. “Although the assumptions made in extrapolating study data to the broader U.S. population may limit the accuracy of our figure, the absence of national data highlights the need for systematic measurement of the problem.”
Also, industry reliance on coding of diseases with systems such as ICD-10 lead to lack of data on medical errors, the study notes. “The ICD-10 coding system has limited ability to capture most types of medical error,” researchers conclude. “At best, there are only a few codes where the role of error can be inferred, such as the code for anticoagulation causing adverse effects and the code for overdose events. When a medical error results in death, both the physiological cause of the death and the related problem with delivery of care should be captured.”
Improved data sharing can advance science in finding causes for medical errors and focusing efforts on eliminating them, “in the same way as clinicians share research and innovation about coronary artery disease, melanoma and influenza.”
Response to the Johns Hopkins report didn’t deny the extent of the problem, but noted the complexity of solving it. Rick Pollack, president and CEO of the American Hospital Association, said much progress has been made since 2008, the latest year on which the BMJ cited data. Deaths from hospital-acquired conditions have declined 17 percent since then.
HIT executives are getting involved in efforts to reduce medical errors, says Marc Probst, CIO at Intermountain Healthcare and board chair of the College of Healthcare Information Management Executives. But he also acknowledges some of the challenges facing IT executives in assuring patient safety in hospital settings.
Probst highlights a CHIME initiative to create a national patient identification system, citing a 2012 study of CHIME members that found 20 percent of survey respondents could attribute at least one adverse medical event to patient identification matching mistakes.
However, implementing IT in healthcare settings is not a panacea, and often involves significant cross-department coordination and cooperation. For example, a 2012 CHIME case study on Cook Children’s Medical Center implementing a bedside medication verification system using bar-coding technology involved careful coordination between information technology, pharmacy, nursing, administration and medical staff.
And while clinical decision support systems can prove helpful, there’s also data that too many alerts are dulling clinicians’ response to them across the board—including those that may have a direct bearing on a needed intervention that could save a life.
“The BMJ authors recommend making errors more visible,” says a spokeswoman from AMIA, a professional organization representing informaticists. “But not all medical errors are fatal, and not all potential errors are of equal value in potential lethality. So making errors more visible may not necessarily be helpful in reducing deaths, unless systems can distinguish the probabilities related to the error type and help clinicians respond more quickly to the error type.”
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