Patient Safety and Medical Errors

The National Patient Safety Problem

• In 1999, the Institute of Medicine published "To Err is Human," which established that 44,000 to 98,000 people die each year due to preventable medical errors in the inpatient setting.

Technology Is Part of the Solution

• A follow-up to "To Err is Human" was published in 2001, "Crossing the Quality Chasm," which emphasized the adoption and use of technology to improve patient safety across all practice settings.

Informatics Education Needs

• In 2003, "Health Professions Education: A Bridge to Quality" was published, highlighting the need for educational reforms in informatics and integrating it into health professions education through accreditation standards.

Health Information Technology (Health IT)

• Health IT is the use of computer hardware, software, or infrastructure to record, store, protect, and retrieve clinical, administrative, or financial information.
• Examples of health IT include electronic health records, patient portals, electronic prescribing, and clinical decision support.

Influences on Technology Adoption in Health Care

• Factors influencing technology adoption in health care include:
  • Desire for improvements in patient safety, quality of care, and efficiency
  • Changes in health care payment structures (e.g., value-based care)
  • National initiatives (e.g., meaningful use)
  • Interoperability (sharing of health information across different electronic health record systems)

The Problem of Paper Records

• Paper records have potential safety problems, such as:
  • Illegibility
  • Inaccuracy
  • Incompleteness

Electronic Health Records (EHRs)

• EHRs are computerized patient care records that can be shared across multiple facilities within a health care system.
• Benefits of EHRs include:
  • Comprehensive health information
  • Legibility
  • Multiple health care professionals can access the record simultaneously
  • Greater detail about the patient

The HITECH Act of 2009

• The Health Information Technology for Economic and Clinical Health (HITECH) Act established the position of the National Coordinator for Health Information Technology.
• The act provided economic incentives for adopting and using electronic health records through the "Meaningful Use Program," which is now integrated into Medicare/Medicaid reimbursement programs.

Electronic Health Record Adoption

• Despite the benefits, electronic health record adoption is not yet 100% due to various reasons.

Interoperability

• Interoperability refers to the ability of different health information systems to "talk" to each other.
• Standards such as Fast Healthcare Interoperability Resources (FHIR) are used to facilitate interoperability.
• Health Information Exchange (HIE) organizations connect different health information stakeholders together, enabling the sharing of health information.

Current Level of Interoperability

• The current level of interoperability is achieved through Qualified Health Information Networks (QHINs), which use a network-of-networks model to connect different health information systems.

How Health IT Helps Pharmacists

• Health IT provides pharmacists with access to information that may not always be available.
• Health IT supports the provision of medication therapy management (MTM) and other chronic disease management services.
• Health IT integrates pharmacist-delivered care, including immunizations, into the electronic health record.

Electronic Prescribing/Computerized Prescriber Order Entry (CPOE)

• Electronic prescribing/CPOE improves patient safety by:
  • Eliminating legibility issues
  • Reducing errors due to leading or trailing zeroes
• However, electronic prescribing/CPOE can also negatively impact patient safety by:
  • Sending incorrect information
  • Allowing default directions to be sent

Clinical Decision Support (CDS)

• CDS improves patient safety by:
  • Automating the identification of drug interactions
  • Providing reminders for preventive care
  • Adhering to clinical guidelines
• However, CDS can also negatively impact patient safety by:
  • Causing alert fatigue, leading to missed alerts and patient harm

Barcode Medication Administration (BCMA)

• BCMA improves patient safety by:
  • Providing an additional double-check to ensure the five rights of medication administration
  • Ensuring the correct medication is used to fill a prescription
• However, BCMA can also negatively impact patient safety by:
  • Allowing workarounds to occur

Barcoding Workarounds

• Common barcoding workarounds include:
  • Scanning the same package multiple times
  • Skipping barcode scanning

Automated Dispensing Machines (ADMs)/PYXIS

• ADMs/PYXIS improve patient safety by:
  • Counting more accurately and faster than humans
  • Limiting inappropriate access to medications
• However, ADMs/PYXIS can also negatively impact patient safety by:
  • Dispensing or leading to wrong medication (machines are filled by humans)
  • Being overridden

Patient Portals

• Patient portals improve patient safety by:
  • Providing access to health records
  • Enabling secure messaging with health care providers
  • Allowing patients to schedule appointments and request medication refills
• However, patient portals can also negatively impact patient safety by:
  • Handling urgent care inappropriately
  • Perpetuating the digital divide

Telehealth

• Telehealth improves patient safety by:
  • Providing access to care that would not otherwise be available to patients
• However, telehealth can also negatively impact patient safety by:
  • Lacking a meaningful care relationship
  • Perpetuating the digital divide

Why Health IT Has Safety Issues

• Health IT systems are often not developed with significant input from end-users (health care professionals).
• There is variability in the way health IT systems can be used.
• Integrating health IT into clinical workflow requires an adjustment and may seem inefficient, leading to workarounds.