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Quality of Care/Patient Safety

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Information technology is one key to improving patient safety

Information technology (IT) can reduce medical errors in several ways, note David W. Bates, M.D., and Atul A. Gawande, M.D., M.P.H., of Brigham and Women's Hospital, in a recent article. Their work was supported in part by the Agency for Healthcare Research and Quality.

Communication failures, especially those during shift changes or "handoffs" between clinicians commonly cause errors. A new generation of technology—including computerized coverage systems for signing out, hand-held personal digital assistants, and wireless access to electronic medical records—may improve the exchange of information, especially if links between various applications and a common clinical database are in place.

Information systems can identify and rapidly communicate problems to clinicians automatically. For example, the combination of a hand-held device and a cellular phone can allow rapid communication from the hospital laboratory to the doctor about a dangerously low serum potassium in a patient and recommended immediate actions to correct it. This is much more efficient than the current system where the lab result goes to the ward clerk who may not recognize the importance of the result and needs to find a clinician. Also, hand-held computers provide point-of-care access to the National Library of Medicine's MEDLINE® database and to drug reference and other information.

One of the main benefits of using computers for clinical tasks is often overlooked. Using the computer makes it possible to implement "forcing functions." For example, prescriptions written on a computer can be "forced" to be legible and complete. Similarly, applications can require constraints on clinicians' choices regarding the dose or route of administration of a potentially dangerous medication. These forcing functions can reduce physician errors and serve as reminders. Technology-enabled remote monitoring of intensive care is an important benefit given the national shortage of intensivists. Computerized tools also can be used with electronic medical records to identify, intervene promptly, and track the frequency of adverse events, for example, hospital-induced infections or dangerous drug reactions.

Although these and other IT strategies hold great promise for improving the quality of health care and reducing medical errors, few have been widely implemented, note Drs. Bates and Gawande. The reasons they cite for slow adoption include uncertainty about the quality of clinical software applications, the absence of widely used standards for this technology application, and the failure of many health care organizations to view IT as a strategic resource rather than a commodity, like plumbing.

More details are in "Improving safety with information technology," by Drs. Bates and Gawande, in the June 19, 2003, New England Journal of Medicine 348, pp. 2526-2534.

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