Information technology (IT) systems appear to be playing a significant role in reducing the number of medical errors in both inpatient and hospital emergency room settings. Recently, 16 California hospitals achieved the status of “Most Wired” on Hospital & Health Network’s (H&HN) 16th annual list. The achievement was based upon the successful implementation of IT in medical environments – IT that is designed to reduce the occurrence and impact of potential patient harm as well as improve communications between hospital staff, administration and patients. For example, according to H&HN, “Among Most Wired hospitals, 81 percent of medications are matched to the patient, nurse and order via bar code technology at the bedside.” However, some patient safety professionals have concerns about the use of IT in emergency medical settings and its potential to increase certain patient safety risks.
The H&HN Most Wired survey was conducted in partnership with the America Hospital Association, The College of Healthcare Information Management, AT&T, CareTech Solutions and the McKesson Corporation. The survey examined how U.S. hospitals are using technology systems to “better connect disparate care providers” as well as connect providers directly to patients. Some 1,900 participating hospitals completed 680 surveys. Three hundred and seventy-five of these hospitals achieved the status of Most Wired based upon criteria that included administration management, clinical integration, clinical quality and safety and infrastructure.
According to H&HN, “Nurses and physicians share best practices for patient safety and use checklists at more than 90 percent of Most Wired organizations.” Further, American Hospital Association CEO Rich Umbdenstock states that this shared health information allows “clinicians and patients to have the information they need to promote health and make the most informed decisions about treatments.”
IT systems implemented in Most Wired environments include online portals to check test results, mobile IT that allows access to patient information, online “chronic disease self-management tools” and secure messaging technology. Even social media comes into play – H&HN states, “35 percent of Most Wired hospitals use social media to deliver care management messages.”
However, there are some clear and present concerns about the use of IT and the potential for actual increased risks to patient safety. The Emergency Medical Patient Safety Foundation (EMPSF) is a national, 501(c)(3) not-for-profit organization that seeks to “identify and respond to challenges of providing safe, quality health care in the practice of Emergency Medicine.” The organization has the overall objective to “prevent harm and save lives” and has a history of identifying patient safety issues and solutions.
Guardian Liberty Voice had the opportunity to obtain a statement about the use of IT in medical environments, specifically emergency departments, from Dr. Drew Fuller, MD, MPH, FACEP board member of EMPSF and Director of Safety Innovation for Emergency Medicine Associates of Maryland. According to Fuller, while EMPSF is “enthusiastic about the advancements and use of electronic medical records in hospitals and emergency departments, the organization does have real and serious concerns about the inherent vulnerabilities in the technology that can lead to increased errors and lapses in care.” One concern expressed by Fuller was “the usability of these systems and the adverse impact on workflow.”
Fuller also addressed the concern that the IT presents the potential for “wrong order, wrong patient order errors (WOWPE’s). Of great concern is the lack of a “good mechanism for transmission of patient data for hand off of patients at shift change in the emergency department or in the admission process to the hospital.”
While acknowledging the potential for advancements in IT to increase patient safety, Fuller stated that EMPSF would like the industry to “assertively seek out and rectify the vulnerabilities that are identified by clinicians and call for the elimination of all gag clauses in vendor contracts that prohibit clinicians from reporting these vulnerabilities in the public sector.” This powerful statement seems to indicate that specific types of information are not being fully disclosed due to certain internal pressures. If so, this could have a negative impact on patient safety.
There is little doubt that inaccurate or unreported information could also have a significant impact on the results of the annual survey by H&HN as to the effectiveness of IT increasing patient safety and communication in medical environments. The 2014 designation by H&HN of sixteen hospitals in California as Most Wired is one that the state was pleased to receive and the use of IT in medical environments is likely to increase rather than decrease. EMPSF’s Fuller hopes that those in the medical and patient safety industry can “work together to effectively address any risk factors” in the utilization of information technology. In addition to the use of IT in medical environments, such cooperation would further advance patient safety.
By Alana Marie Burke