Health IT coordinator targets medical errors

May 1, 2005

Health information technology is not just about wired physicians or better treatment for patients, Dr. David Brailer, the first national coordinator for health information technology, said at the 2005 Healthcare Information and Management Systems Society conference in Dallas. It's about treating the healthcare industry itself.

Health information technology is not just about wired physicians or better treatment for patients, Dr. David Brailer, the first national coordinator for health information technology, said at the 2005 Healthcare Information and Management Systems Society conference in Dallas. It's about treating the healthcare industry itself.

"The epidemic of medical errors is unabated," he said.

Brailer was appointed to the national healthcare information technology position by Health and Human Services Secretary Tommy Thompson last May in response to President Bush's call for widespread deployment of IT to foster improvements in patient safety within 10 years.

"There is no skirting the issue," Brailer said. "We can't wait until the end of the charter. We have to begin to make tough decisions this year or next."

One goal of Brailer's office is to change how decisions are made at the point of care. Besides being the most challenging environment, point of care is the source of all value, he said.

"The goal is to bring electronic health records into practices in order to reduce medical errors and duplicative work and to enable clinicians to do what they try so hard to do: Achieve better outcomes," he said.

A second goal is to make clinicians interconnected. This is essential both to achieve the desired health status benefits and to allow patient portability.

"The challenge is to create an infrastructure to have critical health information available whenever and wherever treatment decisions are being made," Brailer said.

Personalizing care is the goal that will be most visible to patients, he said. Applications such as a patient portal will allow them to interact with their clinicians in a convenient fashion. They can find out information such as lab results, for example, without going to a doctor's office.

Knowing their cholesterol levels helps patients feel in control, Brailer said.

"This really is what healthcare IT is all about-people feeling like they are in control of their healthcare and being able to make decisions and not being told what to do," he said.

Even as information technology is touted as a panacea for medical errors, however, some patient care information systems, such as computerized provider order entry, may actually foster rather than reduce mistakes, according to two new studies.

"In the U.S., Europe, and Australia, we have seen situations in which the system of people, technologies, organizational routines, and regulations that constitute any healthcare practice seemed to be weakened rather than strengthened by the introduction of patient care information systems applications," said Joan Ash, Ph.D., an associate professor of medical informatics and clinical epidemiology at Oregon Health and Science University.

Some information systems are designed or implemented in ways that actually increase the likelihood of errors, she said.

Ash's study does not discuss software bugs, hardware issues, or organizational dysfunction, all of which can theoretically be dealt with through testing before implementation (J Am Med Inform Assoc 2004; 11[(2)]:104-112). It focuses on latent or silent errors that result from the mismatch between information systems and the real-life demands of healthcare.

Some systems require data entry so elaborate that the time spent recording patient data is significantly greater than it was with paper, Ash said. Worse, overly structured data entry can lead to a loss of cognitive focus by the clinician.

"When determining differential diagnosis, the act of writing the information is integral to the cognitive processing of the case," she said.

Similarly, the need to switch between different screens can result in a loss of overview, which some clinicians argue works against their ability to acquire, maintain, and refine a mental command of the case.

Another study found that a widely used computerized physician order entry system facilitated 22 types of medication error risks. Fragmented displays, for example, prevent a coherent view of patients' medications, and pharmacy inventory displays are mistaken for dosage guidelines (J Am Med Inform Assoc 2005;293[10]: 1197-1203).

"Published studies report that computerized order entry reduces medication errors up to 81%, but few researchers have focused on the types of medication errors these systems can facilitate," said Ross Koppel, Ph.D., an adjunct professor at the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania.

As computerized order entry systems are implemented, clinicians and hospitals must attend to the errors they cause, as well as the errors they prevent, he said