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| − | Kaelber DC, Bates DW. Health Information Exchange and Patient Safety. Journal of Biomedical Informatics. 2007 Dec;40(6 Suppl): S40-5. Epub2007
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| − | Kaelber and Bates cite IOM's 2000 Report ''To Err is Human'' which underscores the high number of patient injuries that are iatrogenic. The authors state that patient safety is compromised when the right information is unavailable to the right person at the right time and that these gaps in information are not uncommon in the US healthcare system.
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| − | A two dimensional model (''who'' is involved in the exchange and ''what'' is being exchanged) is used to illustrate that the value of health information exchange (HIE) is optimized when more people and more information are involved.
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| − | The authors identify six different ways of improving patient safety:
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| − | (1) Improved medication information processing which is further subdivided into:
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| − | Drug-allergy information processing
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| − | Drug-dose information processing
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| − | Drug-drug information processing
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| − | Drug-diagnosis information processing
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| − | Drug-gene information processing
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| − | (2) Improved laboratory information processing
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| − | (3) Improved radiology information processing
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| − | (4) Improved communication among providers
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| − | (5) Improved communication between patients and providers
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| − | (6) Improved public health information processing
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| − | The authors acknowledge that while there is substantial evidence of health information technology (HIT) leading to improved patient safety some studies have yielded antithetical results but they point out that these did not look at HIE explicitly. Nevertheless the authors acknowledge four ways increasing HIE can lead to adverse outcomes for patients including the exchange of incorrect patient-specific information; one patient's information being mistaken for that of another; inaccuracies when translating information from one system to another; significant slowing in systems which may occur during HIE implementation.
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| − | Kaelber and Bates state that standards for the type and content of information to be exchanged are necessary prerequisites for efficient HIE. They argue that the widespread use and acceptance of PACS (Picture Archive and Communication Systems) is representative of the benefits that can occur with standardization.
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| − | Another difficulty highlighted by the authors is lack of completeness of the HIE; only ''some'' information may be exchanged unknown to the user and not everyone's information is being exchanged (e.g., paper records, patients opting out of HIE networks.) They argue that at this time there are measures in place to deal with these situations but these may not continue and consequently in those situations where inadequate information is being exchanged patient safety is decreased.
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| − | The authors state that a necessary condition for HIE to improve patient safety is the development of systems with the ability to process and utilize the large increase in digital information.
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| − | '''Comments:''' The authors make a cogent argument that HIE can improve patient safety. In doing so they present a well-balanced discussion by acknowledging some of the challenges of HIE as well as occasions in which HIE can lead to decreased patient safety.
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| − | L. Bernard-Pantin
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| − | [[category:BMI-512-W-08]]
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