Patient Safety: Improving Safety with Information Technology
This is a systematic review of the article entitled “Patient Safety: Improving Safety with Information Technology” by David W. Bates, MD .
- 1 Introduction
- 2 Ways that Information Technology can Reduce Errors
- 2.1 Improving Communication
- 2.2 Providing Access to Information
- 2.3 Requiring Information and Assisting with Calculations
- 2.4 Monitoring
- 2.5 Decision Support
- 2.6 Rapid Response to and Tracking of Adverse Events
- 2.7 Medication Safety and the Prevention of Errors
- 2.8 Summary of Approaches to Prevention
- 2.9 Barriers and Directions for Improvement
- 2.10 Conclusions
- 3 Comments
- 4 Related Articles
Bates introduces information technology (IT) as a significant solution to the ever-growing need for quality and safety in health care and encourages the medical industry to follow the example of other industries in pursuit of mass customization and individualization. He also proposed that sophistication of computers and software has a great potential to minimize harm or injury caused during medical care. In this article, Bates provides an assessment of the current status of information technology with regard to safety and studies the consequences of the implementation of IT for health care, research, and policy.
Ways that Information Technology can Reduce Errors
Three approaches were discussed:
- Preventing errors and adverse events
- Expediting a quick response after an adverse event has ensued
- Following up with adverse events and providing feedback.
Bates described poor communication, especially those that result from inadequate “handoffs” between providers as one of the most common factors contributing to the incidence of adverse events. Modern technology such as computerized coverage systems for signing out, hand-held personal digital devices and wireless access to electronic medical records were determined to be plausible solutions to enhance information exchange. The article also explained that information systems can automatically recognize and quickly communicate problems to clinicians such as an abnormal lab value unlike traditional systems in which such results are communicated to a unit secretary.
Providing Access to Information
Bates noted that access to reference information such as medical literature, textbooks and Medline database are now readily available on computers and point-of-care devices.
Requiring Information and Assisting with Calculations
A primary advantage of IT such “forcing function” was discussed. Forcing function was described as a means to control the way a task is performed. Examples of constraints named in the article include legible order entry and restricted medication dosing/route of administration. Bates termed forcing function as one of the principal means in which computerized physician order entry reduces the rate of errors.
In this section, Bates discusses how computer applications can identify problems and track relations and trends, which can allow clinicians to intervene before an adverse outcome can occur.
Tools that have minimize diagnostic and treatment errors in various clinical settings were evaluated. Information systems were said to assist with work flow by providing access to key information on patients as laboratory values, by calculating weight-based doses of medications, or by flagging patients that have an order for imaging where intravenous contrast material may be unsuitable.
Rapid Response to and Tracking of Adverse Events
Bates assesses the importance of information technology tools such as computerized prescribing, in combination with electronic medical records and clinical decision support with preventing, tracking and providing early intervention for adverse events. For example, one study found that the use of clinical decision support prevented 44% of misses for a team of clinicians.
Medication Safety and the Prevention of Errors
Bates found that the use of computerized physician order entry with clinical decision support greatly reduced common factors contributing towards misinformation and subsequent medication error such as illegible orders, errors of calculation, and errors in transcription.
Summary of Approaches to Prevention
Few comprehensive studies have been conducted to assess the benefits of IT in improving safety in health care. Bates indicated that more research is needed to fully understand how best to provide the effective patient safety tools through IT.
Barriers and Directions for Improvement
It was found that despite major opportunities for improvement and development of patient safety, the adoption of information technology in health care remains slow. Factors contributing to these limitations include:
- Financial Barriers
- Lack of Standards
- Cultural Barriers
The article was concluded by stating that the current difficulties in medical care can be improved by increased use of information technology. Information technology can drastically improve patient safety by providing structured actions such as computerized physician order entry, evidence-based clinical decision support and catching errors.
This article provides an excellent introduction to the mandate to improve patient safety through the use of information technology. Bates provides a thorough assessment of information technology as an essential tool for clinician to provide safe health care.
- Bates, D. Improving Safety with Information Technology. New Engl J Med 2003 348:2526-2534 http://www.nejm.org/doi/pdf/10.1056/NEJMsa020847