It’s patient safety, stupid!

April 15, 2009

Of all the things uttered by President Clinton, the best remembered may be his questioning of what “‘is” is, an ignominious line prompted by an investigation that led eventually to his impeachment. Today that question can be legitimately asked with only a change in capitalization and pronunciation as the information technology world questions the significance of IS (information systems).

Of all the things uttered by President Clinton, the best remembered may be his questioning of what "‘is" is, an ignominious line prompted by an investigation that led eventually to his impeachment. Today that question can be legitimately asked with only a change in capitalization and pronunciation as the information technology world questions the significance of IS (information systems).

PACS developers were among the first to make a strong case for the widespread acceptance of modern information systems. Ever larger imaging files, created by advanced-performance CTs and MRs, along with rapid growth in the installed base of digital mammography and digital radiography systems made PACS a necessity. Hospital information systems, epitomized by products running rule-based algorithms that guide as well as track healthcare processes, promised better efficiency and lower costs. But, until the Obama stimulus plan, with its reimbursement-based approach to the use of healthcare information technology, passed the Congress earlier this year the case for a return on investment was tough to make.

Many of the specifics in the plan remain to be worked out; which information systems will qualify for use and how they must be used in order to generate reimbursement, for example. But these specifics will come very soon.

You can, therefore, easily make the case that the significance of healthcare IS is the corporate bottom line. But there's more to IS than that. Along with the money is the widespread improvement in patient safety that will almost certainly come. The need for such improvement rang through in a keynote address at the Healthcare Information and Management Systems Society 2009 meeting by actor Dennis Quaid, who described how miscommunications late last year led the nursing staff at Cedars-Sinai Medical Center to twice administer 1000 times the common dose of a blood thinner to each of his twins.

The need for improvements in patient safety resurfaced time and again in presentations and exhibits at the HIMSS meeting. Among the most dramatic were claims based on Medicare data indicating that patients treated at the best hospitals had, on average, 43% less risk of experiencing one or more medical errors compared to the poorest performing hospitals; that between 2005 and 2007 nearly a million errors involving Medicare patients were committed; and that these errors led to more than $6.9 billion of wasted healthcare dollars.

In the lead-up to the 1992 presidential election, the Clinton campaign focused on the economy, underscoring the importance of pocketbook issues to a U.S. public that only nine months earlier had been completely absorbed in Middle East politics and an international coalition that beat back a then-powerful Saddam Hussein. The rallying cry among operatives in the Clinton campaign back then was "It's the economy, stupid!"

Today, in the prelude to what could be the biggest change in medical practice in this country's history, the Obama administration is mouthing those words again. But as its stimulus bill affects healthcare, the real gains will be made in patient safety. And they, too, may turn into pocketbook issues, through the elimination of healthcare costs that would otherwise be incurred through stupid mistakes.