Date: Nov. 20, 2003 Contacts: Christine Stencel, Media Relations Officer Chris Dobbins, Media Relations Assistant Office of News and Public Information 202-334-2138; e-mail <firstname.lastname@example.org>
FOR IMMEDIATE RELEASE
Reducing Medical Errors Requires National Computerized Information Systems; Data Standards Are Crucial to Improving Patient Safety
WASHINGTON -- To significantly reduce the tens of thousands of deaths and injuries caused by medical errors every year, health care organizations must adopt information technology systems that are capable of collecting and sharing essential health information on patients and their care, says a new report by the Institute of Medicine of the National Academies. These systems should operate seamlessly as part of a national network of health information that is accessible by all health care organizations and that includes electronic records of patients' care, secure platforms for the exchange of information among providers and patients, and data standards that will make health information uniform and understandable to all, said the committee that wrote the report.
"When it comes to safety, the health care industry needs to borrow a page from the airline industry," said committee chair Paul Tang, chief medical information officer, Palo Alto Medical Foundation, Palo Alto, Calif. "Pilots have instantaneous access to the data they need on weather conditions and mechanical functions to make informed decisions about navigation, delays, and midcourse corrections. When accidents or near misses occur, the industry can analyze these events, and the resulting information can be used to prevent future errors. In health care, no such universal information system exists."
While some hospitals, medical groups, and other health care organizations have installed computer systems to manage patient information, a national infrastructure for standardized data collection and exchange is needed because patients often receive services from many different providers. Routine use of electronic health records would give health care providers and patients immediate access to complete patient information as well as tools to guide decision-making and help prevent errors. "It is time to shift the emphasis of patient safety programs from a strategy of reporting, focused on injuries after they have occurred, to one of prevention aimed at providing safe and effective care in the first place," Tang said.
However, without standards for how and what data is collected, the different systems used in various organizations may not be compatible. "The lack of data standards is a key obstacle to the adoption of both electronic health records and data exchange systems," said committee vice chair Molly Joel Coye, CEO, Health Technology Center, San Francisco. "Physicians and other providers have hesitated to invest in data systems, reasonably so, knowing that their own medical record system might not be able to exchange important patient information with local pharmacies, hospitals, or even other physicians."
To facilitate the routine use of electronic health records, the health care sector must develop and use standardized formats for these records, which allow providers to record information about patients' health at the point of care. In addition, uniform formats and data standards for reporting information on near misses -- mishaps that were caught before harm occurred -- as well as events caused by mistakes must be developed and adopted so that the industry can learn how to prevent future errors.
A 1999 IOM report estimated that up to 98,000 deaths occur every year in U.S. hospitals as a result of medical errors. Recent studies show that tens of thousands of additional errors occur in nursing homes and clinics. Moreover, patients in all health care settings receive on average just slightly over half the tests, procedures, and other care that is recommended for their conditions, according to another study.
The private sector can be expected to invest a significant portion of the capital required to build a national system of computerized health information and data sharing. However, federal investments should support the development of critical building blocks of this infrastructure, especially those that are unlikely to receive adequate support from the private sector, such as a secure platform for data exchange. The government also should provide financial incentives to spur private-sector development of electronic health record systems. The committee acknowledged that sizable investments will be needed to build the infrastructure, but noted that the resulting tools and information could yield significant benefits for other areas as well, including homeland security and public health.
Uniform information technology standards for the collection, storage, and dissemination of health information are crucial to the national infrastructure. The U.S. Department of Health and Human Services should take the lead in establishing a public-private partnership to develop and promote national health data standards. The report outlines a plan to accelerate the development of data standards in three key areas: clinical terminologies, exchange of data among computers, and representation of medical information in computer programs.
Government health care programs -- which pay for more than 40 percent of all health care expenditures – should encourage adoption of these national data standards by incorporating them into their contractual and regulatory requirements. For example, adherence to the standards should be one of the conditions for participation in Medicare programs.
As part of the effort to achieve an acceptable standard of patient safety, all health care settings must establish comprehensive patient safety programs operated by trained personnel, the report adds. They must establish a culture in which patient safety is a top priority.
The study was sponsored by the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services. The Institute of Medicine is a private, nonprofit institution that provides health policy advice under a congressional charter granted to the National Academy of Sciences. A committee roster follows.
Patient Safety: Achieving a New Standard for Care is available on the Internet at http://www.nap.edu. Copies of the report will be available for purchase early next year from the National Academies Press; tel. 202-334-3313 or 1-800-624-6242. Reporters may obtain a pre-publication copy from the Office of News and Public Information (contacts listed above).
INSTITUTE OF MEDICINE Board on Health Care Services
Committee on Data Standards for Patient Safety
Paul C. Tang, M.D. (chair) Chief Medical Information Officer Palo Alto Medical Foundation Palo Alto, Calif.
Molly J. Coye, M.D., M.P.H. (vice chair) Chief Executive Officer Health Technology Center, and Senior Fellow Institute for the Future San Francisco
Suzanne Bakken, R.N., D.N.Sc., F.A.A.N. Alumni Professor of Nursing, and Professor of Biomedical Informatics Columbia University New York City
E. Andrew Balas, M.D., Ph.D. Dean School of Public Health, and Professor of Health Policy Saint Louis University St. Louis
David W. Bates, M.D., M.Sc. Chief Division of General Medicine Brigham and Women's Hospital; Medical Director Clinical and Quality Analysis Partners Healthcare System; and Associate Professor of Medicine School of Medicine Harvard University Boston
John R. Clarke, M.D., F.A.C.S. Professor of Surgery Drexel University; Adjunct Professor of Computer and Information Science University of Pennsylvania; and Adjunct Senior Fellow Leonard Davis Institute of Health Economics Philadelphia
David C. Classen, M.D., M.S. Vice President First Consulting Group, and Associate Professor of Medicine and Consultant in Infectious Diseases School of Medicine University of Utah Salt Lake City
Simon P. Cohn, M.D., M.P.H., F.A.C.E.P. National Director Health Information Policy Kaiser Permanente Medical Care Program Oakland, Calif.
Carol Cronin, M.S.W., M.S. Independent Consultant Annapolis, Md.
Jonathan S. Einbinder, M.D., M.P.H. Assistant Professor Harvard Medical School, and Corporate Manager Partners Healthcare Information Systems Boston
Larry D. Grandia, M.E. Chief Technology Officer and Executive Vice President Premier Inc. San Diego
W. Ed Hammond, Ph.D. Professor Emeritus Division of Medical Informatics Duke University Durham, N.C. Brent C. James, M.D., M.Stat. Executive Director Institute for Health Care Delivery Research, and Vice President Medical Research and Continuing Medical Education Intermountain Health Care Salt Lake City
Kevin B. Johnson, M.D., M.S. Associate Professor and Vice Chair Biomedical Informatics, and Associate Professor Department of Pediatrics School of Medicine Vanderbilt University Nashville, Tenn.
Jill Rosenthal, M.P.H. Project Manager National Academy for State Health Policy Portland, Maine
Tjerk W. van der Schaaf, Ph.D. Associate Professor Human Factors in Risk Control Eindhoven University of Technology Eindhoven Safety Management Group Department of Technology Management Eindhoven, Netherlands