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'Health information exchange and patient safety- Another review

David C. Kaelber, David W. Bates

One of the most promising advantages for health information exchange (HIE) is improved patient safety. Up to 18% of the patient safety errors generally and as many as 70% of adverse drug events could be eliminated if the right information about the right patient available at the right time. The authors discuss a variety of areas in which HIE can impact patient safety. They also briefly discuss HIE and decreased patient safety as well as standards and completeness of information for HIE and patient safety.

A. Health information exchange and increased patient safety

1. Improved medication information processing The authors divide HIE’s impact on medication information processing into five subsections

1.1. Drug-allergy information processing. This involves checking drugs against known patient-specific drug allergies before the drugs are given to the patient.

1.2. Drug–dose information processing. (1) Being sure that the individual dose, dosing frequency, and total duration of medication fall within accepted general standards. (2) taking into account patient specific information such as patient age (geriatric dosing), weight (pediatric dosing), and creatinine clearance (renal dosing).

1.3. Drug–drug information processing. (1) Adding an additional medication(s) to a patient’s other medications. (2) Duplicate pharmacological class checking. (3) When one medication is being added that could indicate the addition of another medication for improved patient safety.

1.4. Drug-diagnosis information processing. (1) Taking into account medical conditions and contraindications that would affect drug dosing or administration at all. (2) Checking if the drug being prescribed is indicated for any of a patient’s diagnoses. This would help eliminate inappropriate sound-alike/look-alike medications from being prescribed such as clonidine and klonopine.

1.5. Drug–gene information processing. As gene analysis and pharamocogenomics becomes more developed, the ability to interchange drug information and patient-specific genomic information will become increasing important for patient safety.

2. Improved laboratory information processing (1) Helping to ensure that indicated lab testing is ordered (2) helping to guarantee that lab test results (especially abnormal results) are appropriately followed up on. HIE is particularly critical in this process in this era of few in-office tests, many ‘‘send-out’’ tests, and numerous independent laboratories.

3. Improved radiology information processing Typically the provider ordering an imaging study is different from the provider interpreting the imaging study. Therefore, health information has to be exchanged between these two health professionals for the radiology study to electively ordered, interpreted, and to ensure appropriate follow-up of abnormal radiology findings.

4. Improved communication among providers When different primary care providers and/or subspecialists are managing different medical issues, effective information sharing is critical.

5. Improved communication between patients and providers Examples include patients checking PHRs for errors in their medical history, adding additional valuable information into their medical records, following up on their own test results, reviewing medications and other healthcare instructions, and being able to communicate more quickly with healthcare providers when they think their safety may be at risk. PHRs may also allow providers to more quickly and more accurately provide information to their patients, which should improve patient safety.

6. Improved public health information processing A rapidly growing area of HIE is public health informatics. Patient safety could be greatly enhanced through this growth. Opportunities for improved patient safety in this area include post-marketing drug surveillance, infectious disease surveillance, biohazard surveillance, and environmen