IT can substantially improve the safety of medical care but few of the technologies likely to achieve this are implemented, according to a major US review of the subject published in the New England Journal of Medicine.
The review’s authors from Brigham and Women’s Hospital, the Center for Applied Medical Information Systems, Partners HealthCare System and Harvard Medical School, all in Boston, identify seven ways in which IT can aid safety. However, they identify financial and cultural barriers and the lack of common US standards for most types of clinical data as factors militating against the widespread adoption of such IT safety measures.
The seven, referenced, researched routes to improved safety are:
• Improved communication – especially in handovers of patients and when a serious abnormality identified by a laboratory test needs to be pulled out from less critical data.
• Providing increased access to information through the availability of textbooks, drug reference works and bodies of information such as Medline via both desktop and handheld computers.
• Requiring information and assisting with calculations. IT can use “forcing functions” that restrict the way tasks are performed and prevent dangerous practices such as the issue of illegible or incomplete prescriptions or the administration of potentially dangerous doses of medication. The researchers point out that more than 600 drugs require dose adjustment for multiple levels of renal dysfunction – a task poorly performed by human prescribers without computer assistance.
• Monitoring functions which are inherently badly performed by human beings. Automated monitoring can incorporate applications to track trends and relations which enable a clinician to respond before an adverse event occurs.
• Decision support can make available key information such as weight based medication doses or “red flag” actions that may be inappropriate for some patients. The authors predict that more sophisticated tools such as computerised algorithms and neural networks will bring longer term benefits in this area.
• Rapid response and tracking of adverse events. The authors say computerised tools can be used with electronic records to identify, intervene early in and track adverse events. They point to a study which showed that 44% of the alerts generated by a computerised tool had not been identified by clinicians.
• Medication safety and the prevention of errors. The review points out that nearly half of all serious medication errors result from the fact that the clinicians have insufficient information about the patient and the drug.
The reviewers concede, however, that only a few types of technology have been well-tested. They identify a lack of enthusiasm for such research in academic centres where drug or device research tends to be favoured over clinical decision support studies which may have far greater potential to save lives.
Furthermore the paper says clinicians have been reluctant to adopt IT, even when it has been shown to be effective.
The authors say: "Not only the government but clinicians too, in their practices and relationships with colleagues, must recognise that most preventable adverse events result from failures of systems, not failures of individuals. Investment in and adoption of new forms of information technology must be understood as being as vital to good patient care as the adoption of new technological tools for diagnosis and treatment."