Term Paper on "Addressing the Issue of Medical Errors With Mandatory Reporting Systems and Computer Technology"
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Healthcare: Addressing the Issue of Medical ErrorsHealthcare
Addressing the Issue of Medical Errors with Mandatory
Reporting Systems and Computer Technology
To combat the current crisis of deaths due to preventable medical errors the health care industry and lawmakers have taken two approaches. The first is the implementation of a system of mandatory reporting systems. The solution is to crate an atmosphere in hospitals that fosters less blame, not more, according to the IOM report. A blue-ribbon pane appointed by the IOM argues that the failure to acknowledge and analyze mistakes deprives hospitals of important information that could help prevent similar mistakes in the future. However, many in the healthcare industry argue that mandatory reporting of errors will foster an atmosphere of lawsuits and backlash by the public. The end results would be increased costs, higher insurance premiums, and an overall distrust of hospitals and other healthcare facilities. The Joint Commission states that it is fully supportive of creating an effective health and medical care error reporting system either voluntary or mandatory with characteristics expressed in events to be reported to the system be well defined. If the system is one that is Mandatory then the system should be limited to serious adverse events. . The fears of improper disclosure have been shown to be barrier or challenge as well as funding due to lack of federal funding for these programs however, due to the lack of legislation in this area these programs are vital for implementation to ensure patient safety in the future.
- Healthcare
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Addressing the Issue of Medical Errors with Mandatory
Reporting Systems and Computer Technology
Table of Contents
Abstract
1
Introduction
3
Medical Errors Background Information
6
Stakeholders
10
Type of Errors
10
Mandatory Reporting Systems
13
Challenges
14
Legal Protection of Error Information
14
Public Disclosure of Errors
16
Legislation
18
Patient Involvement
25
Recommended Guidelines
27
Elements Impacting Mandatory Reporting Costs
30
The Mandatory System at Work: Florida & NY
31
Use and Analysis of Data: Florida
32
Use and Analysis of Data: New York
32
Cost Analysis of Reporting Programs
34
Summary and Conclusion
39
- Healthcare
Addressing the Issue of Medical Errors with Mandatory
Reporting Systems and Computer Technology
Introduction
Experts have known for some time the medical errors are widespread and have been for over a decade. However, the problem has not received a new dose of attention from the public and Congress following a recent report from the prestigious Institute of Medicine (IOM) giving confirmation to the extent of the phenomenon and urging reforms. In fact, more people die each year due to preventable medical mistakes in American hospitals than are killed in car crashes or by breast cancer or AIDS. To combat the current crisis of deaths due to preventable medical errors the health care industry and lawmakers have taken two approaches. The first is the implementation of a system of mandatory reporting systems.
The solution is to crate an atmosphere in hospitals that fosters less blame, not more, according to the IOM report. A blue-ribbon pane appointed by the IOM argues that the failure to acknowledge and analyze mistakes deprives hospitals of important information that could help prevent similar mistakes in the future. However, many in the healthcare industry argue that mandatory reporting of errors will foster an atmosphere of lawsuits and backlash by the public. The end results would be increased costs, higher insurance premiums, and an overall distrust of hospitals and other healthcare facilities.
On the other hand, current research evidence shows that when compared to paper-based systems, the optimal solutions for the prevention of medical errors are high-tech in nature. When implemented these solutions show marked reduction in all types of medical errors. The success of any rollout involving new hardware and software hinges on the collaborative and effort building between IT managers and the company employees. Possession of the high-end technology in itself alone without the willingness of the end-users to undergo proper training and then followed by a sincere effort to properly use the newly installed computer information systems. Likewise the IT management teams must access end-user needs as well as incorporating their suggestions into the finalized decision in the process. When these situations exist simultaneously with the end result being that of achievement.
Because we are in a computer/digital age coupled with the fact that healthcare organizations are trying to reduce or eliminate medical errors with alternative solutions, an in-depth discussion of high-techs options is highly relevant for hospital administrators and IT management to consider. This is specifically the case when uses of these systems reduce error rates dramatically; thereby positively affecting the health care patients receive. In addition, a net effect of reduction in heath care costs cannot be over looked. Today these pressing issues of are of an immense proportion to all American as the healthcare systems in the U.S. is poised to undergo significant changes in the near future." With the recent YIPA legislation, possible privatization of Medicare, new innovations including Wi-Fi Internet access, mobile computing, remote access and a never ending quest to eliminate costs, hospital IT management must always be cognizant of new technology as it materializes.
When making examination of the successful introduction and final adoption of high-tech solutions into the health care system, one must review the whole picture before and after implementation. By studying the overall characteristics of an organization, assumptions can then be made as to why certain applications are readily accepted while others are not. Also the same reasoning can be applied to the assessment of why particular departments within healthcare institutions welcome change while others resist at every step along the process of upgrading. Common areas of interests include the following:
Educational background of employees to be affected by the new computer system
Attitudes, perception, and biases toward computer technology
Educational background of employees to be affected by the computer systems.
Level of communications between different departments
Relationship between upper management, IT Personnel, and end users.
The extent of the problems leading to medical errors
Employee training and evaluations
The Technologies (hardware and software)
Medical Errors: Background information
Type of Errors
There are several types of medical errors and each of these may be inclusive in the category of "Diagnostic," "Treatment," "Preventative," or "Other."
Diagnostic
Error or delay in diagnosis
Failure to employ indicated tests
Use of outmoded tests or therapy
Failure to act on results of monitoring or testing
Treatment
Error in the performance of an operation, procedure, or test
Error in administering the treatment
Error in the dose or method of using a drug
Avoidable delay in treatment or in responding to an abnormal test
Inappropriate (not indicated) care
Preventative
Failure to provide prophylactic treatment
Inadequate monitoring or follow-up treatment
Preventative
Failure to provide prophylactic treatment
Inadequate monitoring or follow-up treatment
Other
Failure of communication
Equipment failure
Other system failure
The extremely complex issues associated with health care reporting systems demand critical examination before implementation of a system. Healthcare systems serve two main purposes, which are:
1.
Holding professionals accountable for their performance
2.
Improving Patient Safety
In a study conducted at Columbia University focused on the subject of medical errors the five search terms utilized as those of 'mistake', 'error', 'incorrect', 'inadvertent' and 'iatrogenic in the surveying of sets of multiple reports that are in the nature of a narration. The stated goals of the study are:
1) Measure the rate at which medical errors were documented in medical records; and
2) Characterize the types of errors that were identified.
Discovered were 222 medical errors in 286,000 discharge summaries from 1991-2000, 9 medical errors in 48,000 outpatient notes and 11 medical errors in 49.500 sign out notes. Keyword searches are stated to have "detected a broad range of errors, including medication, diagnosis, surgery, service, and administration error. The most common of the documented error were those that were 'therapeutic-related. The errors that were termed 'therapeutic errors were for the most part those which were of the nature of medication related errors. The errors were found throughout all four stages in the drug ordering and delivering system, which are:
Physician Ordering
Transcription and Verification
Pharmacy dispensing and delivery, and Nurse and Administration
Narrowing the category further, of those errors that were medication related the two main errors were those of:
Wrong dosage
Wrong Frequency
Wrong Drug Use
The breakdown of sections of discharge summaries revealed the following information in the chart below labeled Chart 2.0
Chart 2.0
Detected Medical Errors
Detected in the section "hospital course"(62.2%)
53
Detected in the section "history of present illness" (23.9%)
31
Detected elsewhere (14.0%)
67% of 'new' errors were reported in the "History Course"
75% percent of old errors are reported in the "History of Present Illness"
Implications of the study were that: "Voluntary reporting and mandatory reporting systems play a valuable role in error detection and are in widespread use." Nevertheless the systems reportedly, "miss most errors and adverse events, and usually have poor physician participation." Furthermore the reports have omitted details… READ MORE
Quoted Instructions for "Addressing the Issue of Medical Errors With Mandatory Reporting Systems and Computer Technology" Assignment:
“(TITLE PAGE):
Addressing the Issue of Medical Errors: Mandatory Reporting Systems and Computer Technology
(MAIN TOPIC): (Introductory Paragraphs Listed Below)
Experts have known that medical errors are widespread for more than a decade. But the problem has received a new dose of attention from the public and Congress following a recent report from the prestigious Institute of Medicine (IOM) confirming the extent of the phenomenon and urging reforms. In fact, more people die each year from medical mistakes in American hospitals than are killed in car crashes or by breast cancer or AIDS.
To combat the current crisis of deaths due to preventable medical errors, the health care industry and lawmakers have taken two approaches. The first is to implement a system of mandatory reporting systems. The solution here is to create an atmosphere in hospitals that fosters less blame, not more, according to the IOM report. A blue-ribbon panel appointed by the IOM argues that the failure to acknowledge and analyze mistakes deprives hospitals of important information that could help prevent similar mistakes in the future. However, many in the health care industry argue that mandatory reporting of errors will foster an atmosphere of lawsuits and backlash by the public. The end result would be increased costs, higher insurance premiums, and an overall distrust of hospitals and other health care facilities.
On the other hand, current research evidence shows that when compared to paper-based systems, the optimal solutions for the prevention of medical errors are high-tech in nature. When implemented these solutions show markedly reduction in all types of medical errors. The success of any rollout involving new hardware and software hinges on the collaborative effort between IT managers, administrators, programmers and the end-users themselves. It is not sufficient to possess the high-end technology without the willingness of the end-users to undergo proper training followed by a sincere effort to properly use the newly installed computer information systems. Likewise, the IT management team must access end-user needs and incorporate their suggestions into the final decision making process. When both of these situations exist simultaneously, the end result is one of achievement.
Because we are in a computer/digital age coupled with the fact that healthcare organizations are trying to reduce or eliminate medical errors with alternative solutions, an in-depth discussion of high-tech options is highly relevant for hospital administrators and IT management to consider. This is especially the case when uses of these systems reduce error rates dramatically; thereby positively affecting the health care patients receive. In addition, a net effect of reduction in health care costs cannot be overlooked. Today, these pressing issues are of immense importance to all Americans as the health care system in the United States is poised to undergo significant changes in the near future. With the recent HIPPA legislation, possible privatization of Medicare, new innovations including Wi-Fi Internet access, mobile computing, remote access and a never ending quest to eliminate costs, hospital IT management must always be cognizant of new technology as it materializes.
When examining the successful introduction and final adoption of new, high-tech solutions into the health care system, one must review the whole picture before and after implementation. By studying the overall characteristics of an organization, assumptions can then be made as to why certain applications are readily accepted while others are not. Also, the same reasoning can be applied to the assessment of why particular departments within healthcare institutions welcome change while others resist at every step along the process of upgrading. Common area of interests include the following:
· Educational background of employees to be affected by the new computer systems
· Attitudes, perceptions, and biases toward computer technology
· Level of communications between different departments
· Relationship between upper management, IT personnel, and end users
· The extent of the problems leading to medical errors
· Employee training and evaluations
· The technologies (hardware & software)
(PRELIMINARY OUTLINE)
I. Medical Errors: Background information
II. Solution One: Mandatory Reporting Systems
A. Benefits
B. Drawbacks and Challenges
C. Stakeholders
D. Legislation
E. Conclusions
III. Solution Two: Computer Technology
A. Clinical Decision Support Systems
B. Computerized Physician Order Entry
C. Electronic Medical Record
D. E-prescribing
E. E-health
F. Advantages Disadvantages
IV. The Obstacles for Solutions Implementation
A. The Human Factor
B. Cost (Funding)
C. Lack of Standards (Protocols)
D. Limitations of Technologies
V. Conclusions
(REFERENCES LIST) (you may add other sources as needed)
(BOOKS):
--Kohn, L.T., Corrigan, J.M., & Donaldson, M.S. (2000). To Err Is Human: Building a Safer Health System. Washington, D.C., National Academy Press.
(JOURNALS):
--Bates, D.W., & Gawande, A.A., Improving Safety with Information Technology. (2003). New England Journal of Medicine, 348: 2526-2534.
--Bates, D.W. et al, Effect of computerized Physician Order Entry and a Team Intervention on Prevention of Serious Medication Errors. (1998). Journal of the American Medical Association, 280: 1311-1316
--Hagland, M., Reduced Errors Ahead. Health Care Informatics, August, 2003.
--Hersh, W.R., Medical Informatics: Improving Health Care Through Information. (2002). Journal of the American Medical Association, 288:1955-1958.
--Benjamin, M.D., Reducing Medication Errors and Increasing Patient Safety: Case Studies inClinical Pharmacology. (2003). Journal Of Clinical Pharmacology, 43: 768-783.
--Eskew, A., Geisler, M., O’Connor, L., Saunders, G., Vinci, R., Enhancing Patient Safety: Clinician Order Entry with a Pharmacy Interface. (1999). Journal of Health Care Information Management, 16: 52-57.
--Hayward, R.A., Hofer, T.P., Estimating Hospital Deaths Due to Medical Errors. (2001). Journal of the American Medical Association, 286: 415-420.
--Hunt, D.L., Haynes, R.B., Hanna, S.E., Smith, K, Effects of Computer-Based Clinical Decision Support Systems on Physician Performance and Patient Outcomes. (1998). Journal of the American Medical Association, 280: 1339-1346.
--John Wiley & Sons, Inc. Journals --Bates, D.W., & Gawande, A.A., Improving Safety with Information Technology. (2003). New England Journal of Medicine, 348: 2526-2534.
--Berner, E.S., Maisiak, R.S., Cobbs, C.G., Taunton, O.D., Effects of a Decision Support System on Physicians, Diagnostic Performance. (1999). Journal of the American Medical Informatics Association, 6 (5): 420-427.
--Persson, M., Mjorndal, T., Carlberg, B., Bohlin, J., Lindholm, L.H., Evaluation of a Computer-Based Support System for Treatment of Hypertension with Drugs: Retrospective, Nonintervention Testing of Cost and Guideline Adherence. (2000). Journal of Internal Medicine, 247: 87-93.
--Randolph, A.G., Haynes, R.B., Wyatt, J.C., Cook, D.J., Guyatt, G.H., How to use an Article Evaluating the Clinical Impact of a Computer-Based Clinical Decision Support System. (1999). Journal of the American Medical Association, 281:67-74.
--Friedman, C.P., Elstein, A.S., Wolf, F.M., Murphy, G.C., Franz, T.M., Heckerling, P.S., Fine, P.L., Miller, T.M., Abraham, V., Enhancement of Clinicians’ Diagnostic Reasoning by Computer-Based Consultation. (1999). Journal of the American Medical Association, 282:1851-1856.
--Durieux, P., Nizard, R., Ravaud, P., Mounier, N., Lepage, E., A Clinical Decision Support System for Prevention of Venous Thromboembolism. (2000). Journal of the American Medical Association, 283:2816-2821.
--Raschhke, R.A., Gollihare, B., Wunderlich, T.A., Guidry, J.R., Leibowitz, A.I., Pierce, J.C., Lemelson, L., Heisler, M.A., Susong, C., A Computer Alert System to Prevent Injury from Adverse Drug Events. (1998). Journal of the American Medical Association, 280:1317-1320.
--Britto, J. & Ramnarayan, P., Paediatric Clinical Decision Support Systems. (2002). Arch.Dis.Child, 87: 361-362.
--Chan, W., Increasing the Success of Physician Order Entry Through Human Factors Engineering. Journal of Health Care Information Management, 16: 71-79.
--Leape, L.L., Berwick, D.M., bates, D.W., What Practices Will Most Improve Safety? (2002). Journal of the American Medical Association, 288: 501-507.
--Memel, D.S., McMillan, D.R., Donelson, S.M., Sheehan, M., Development and Implementation of an Information Management and Information Technology Strategy for Improving Health Care Services: A Case Study. (2001). Journal of Health Care Information Management, 15: 261-285.
--Noffsinger, R., Chin, S., Improving the Delivery of Care and Reducing Health Care Costs with the Digitization of Information. (2000). Journal of Health Care Information Management, 14: 23-30.
--Rose, E., Life After Go-Live, Part 4: Preventing Error with an EMR. (1999). Journal of Health Care Information Management, 17: 15-17.
(REQUIRED SECTIONS):
1. Title Page
2. Table of Contents (list every heading with page number)
3. Introduction
4. Literature Review
5. Methodology
6. Results and Findings
7. Discussion
8. References Pages
-Use APA Style according to the Publication Manual of the American Psychological Association
-Contact me as soon as possible if you have any questions regarding format, content, etc.
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