Patient Safety Two Decades After IOM Report
Substantial Patient Safety Risks Remain Two Decades after IOM Report
Summary
The availability of electronic health records with clinical decision support tools and interventions have evolved since the 1999 IOM report, however, their impact on patient safety have been inconsistent.
Current evidence indicates a persistent and sustained level of safety risks.
Rapid knowledge exchange via a national data warehouse model and providing real time clinical and administrative data will help improve outcomes.
Background
The Institute of Medicine 1999 report “To Err is Human” with approximately 98,000 deaths and 1 million inpatient injuries, highlighted the issue of medical errors and patient safety. Over the past two decades, despite broad adoption of electronic health records (EHRs) due to meaningful use incentives, with clinical decision support (CDS) tools, recent reports indicate variable results on patient safety.
Review
Medications are one of the most common causes of harm. In 2009, the federal government implemented incentives to adopt computerized provider order entry systems (CPOE) as part of the EHR meaningful use criteria. These CPOE CDS tools consist of: Basic (drug-allergy, drug-drug interactions, therapeutic duplication, etc.) and; Advanced (drug-laboratory interactions, drug-age warnings, drug-diagnosis contraindications). Recent data from 2,314 hospitals using the Leapfrog CPOE EHR evaluation tool indicate wide variability with the persistence of substandard safety risks over a 10-year period (Figure 1).
Evidence based tool and strategies to improve patient safety have not been incorporated into practice.
The risk of harm can be reduced, even in situations where an obvious error has not been made.
Health information technology can have a positive impact on patient safety but the outcome from these interventions are inconsistent due to variability in their implementation and scaling of successful intervention practices.
With the evolution of technology and EHRs, additional safety issues have emerged and are outlined in Table 1.
Since 2008 CMS has invoked penalties for certain patient safety events. These payment penalties occur with either hospital acquired conditions or when harm occurs. This approach may shift the attention of health systems toward avoiding the payment disincentives, and away from improving safety issues.
Conclusions
Solutions to improve patient safety consist of:
Promoting rapid knowledge exchange between health systems of data, CDS content and sharing of knowledge contained within the EHR via a national clearinghouse to disseminate best practices.
Improved monitoring and care of patients via relevant dashboards providing real time clinical and administrative data on performance and early predictions of patients most vulnerable to developing an adverse event.
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