Electronic systems can promote safety, study says

Electronic records facilitate error prevention

Are you lobbying for your organization to make a capital investment in information technology systems? A new report from the Washington, DC-based Institute of Medicine (IOM) may give you added ammunition.

According to the IOM report Patient Safety: Achieving a New Standard for Care, information technology systems capable of collecting and sharing patient medical records can have a dramatic effect on quality.

These systems should be part of a national network of health information that is accessible by all health care organizations and includes electronic patient records, secure platforms for the exchange of information among providers and patients, and data standards that will make health information uniform and understandable to all, according to the committee that wrote the report.

"Our goal is to create a new standard of care," says Paul C. Tang, MD, committee chair and chief medical information officer at Palo Alto (CA) Medical Foundation.

"In aviation, when a plane crashes, you investigate. In some cases, that is like the quality world — when an outbreak of infection occurs, we determine what caused it," he explains.

In addition to learning from past incidents, there should be a renewed emphasis on preventing them from occurring in the first place, Tang adds.

"When we talk about mistakes, we typically focus on errors of commission. But we also have a lot of errors of omission — things that if we were to do, we would have better outcomes or less infections," he says.

A 1999 IOM report estimated that up to 98,000 deaths occur every year in U.S. hospitals as a result of medical errors.

The goal is to shift the emphasis of patient safety programs from a strategy of reporting infections or injuries after they have occurred, to one of prevention aimed at providing safe and effective care in the first place, Tang says.

"That is where we believe electronic health record systems play a role," he says. "We are interested in having people make the right decisions the first time. So you can think of infection control as infection prevention instead of infection reporting."

Since every patient has contact with a number of providers, the lack of ability to communicate data among those caregivers and their computer systems is a major impediment to patient safety, Tang emphasizes.

"One of the main reasons we don’t communicate well is because there is no standard way of connecting systems and transmitting data," he says. "In order to improve overall quality, we think you need these electronic systems."

Currently, infection control reporting requires staff to make the effort to send a report to the quality manager, Tang says.

"Imagine a world where instead of asking people to fill out a separate report, the data system was able to produce a quality report as a by-product of the care process," he says.

"Basically, when the computer detects a post-op infection, it can send a message automatically to the quality manager," Tang points out.

More accurate data available

You also get more accurate data, he adds. "Instead of infections being reported only when someone remembers to take the time, you will have much closer to 100% of the infections reported."

One of the major obstacles to implementing electronic systems is financial, Tang acknowledges. "It does take a lot of money; but if you spend this money, it not only helps you with quality, it also helps you save money.

"The same system that will help quality, reporting, and patient safety will also help cost," he says.

While working at Chicago-based Northwestern Memorial Hospital, Tang recalls Joint Commission surveyors being very impressed by the facility’s electronic record system.

"And in a very short time, you won’t be able to keep up with the regulations on paper — it will be too much." There is a definite trend in organizations switching to electronic records, Tang states.

"The benefits are becoming clearer. It’s almost becoming a necessity for doing business in this industry," he says. "It’s like banking; you can continue to courier money, but it’s just a whole lot easier to do electronically."

[For more information, contact:

Paul Tang, MD, Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA 94301. Phone: (650) 254-5200.

A copy of the Institute of Medicine report on patient safety can be ordered at the National Academies Press web site: www.nap.edu. Click on "Medicine/Public Health," "Patient Safety: Achieving a New Standard for Care." Or contact National Academies Press, 500 Fifth St. N.W., Lockbox 285, Washington, DC 20055. Phone: (202) 334-3313 or (800) 624-6242. E-mail: zjones@nas.edu.]