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 Table of Contents  
REVIEW ARTICLE
Year : 2013  |  Volume : 1  |  Issue : 4  |  Page : 195-199

The role of health information technology in reducing preventable medical errors and improving patient safety


1 Department of Health Information Technology, School of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
2 Department of Health Information Technology, School of Health Management and Information Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
3 Health Management and Economics Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Date of Web Publication16-Apr-2014

Correspondence Address:
Mahtab Kasaei
Department of Health Information Technology, School of Health Management and Information Sciences, Isfahan University of Medical Sciences, Isfahan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-9019.130378

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  Abstract 

Medical errors have become an increasing public concern among policy-makers, healthcare providers and experts. Medical errors in the U.S. hospitals and healthcare institutions are the third leading cause of death and almost 98,000 people annually lose their lives in this way. According to healthcare and health industry leaders, using information technology enhances patient safety by preventing medical errors, assessment errors and surveillance system with rapid response and reduces the risk of harm created after the fact. In this paper, medical errors are investigated, the role of information technology in reducing and preventing medical errors is investigated, and recommendations are presented regarding the use of information technology for prevention and reduction of medical errors in healthcare institutions. Scientific databases and electronic journal citations were searched to identify articles that discussed the role of health information technology in reducing preventable medical errors and improving patient safety. We used reference tracking and citation methods and searched by following keywords: Information technology, medical errors, computerized provider order entry (CPOE), and clinical decision support system (CDSS). A total of 33 related articles were included in this study from the 609 articles initially obtained from the searches. Nature of medical errors occurring in healthcare organizations includes medication prescribing, treatment, procedures, diagnostic and administrative errors. Among systems and techniques that are used to prevent and reduce medical errors, CPOE, CDSS, EHR (Electronic Health Record), BCMA (Barcode Medication Administration) and RFID (Radio Frequency Identification) are well known. Studies show that in reducing errors, and improving quality of care, CPOE, CDSS and EHR are more effective than other technologies. The integration of CPOE with CDSS, also likely leads to a further reduction of medical errors. CPOE covers all three healthcare quality problems (low use, misuse and overuse). Furthermore, EHR increases the effectiveness of healthcare and reduces medical errors through reminders, alerts and internal intelligent capabilities.

Keywords: Barcode medication administration, clinical decision support system, computerized provider order entry, electronic health records, information technology, medical errors, patient safety


How to cite this article:
Ehteshami A, Rezaei P, Tavakoli N, Kasaei M. The role of health information technology in reducing preventable medical errors and improving patient safety. Int J Health Syst Disaster Manage 2013;1:195-9

How to cite this URL:
Ehteshami A, Rezaei P, Tavakoli N, Kasaei M. The role of health information technology in reducing preventable medical errors and improving patient safety. Int J Health Syst Disaster Manage [serial online] 2013 [cited 2019 Nov 17];1:195-9. Available from: http://www.ijhsdm.org/text.asp?2013/1/4/195/130378

1Institute of Medicine 2Food and Drug Administration 3Veterans Health Administration



  Introduction Top


One of the most recent developments in the healthcare industry over the past 25 years is the development of information and communication technology in the industry. [1] This technology has a significant impact on healthcare organizations, specialists' performance, Patients, various diseases and treatment management. [2] Pioneers of the national health industry recommend the use of information technology as a strategy to improve the quality of patient safety. Examples of these cases, is its impact on patient safety through the prevention of medical errors and adverse effects. [3] Medical errors are an increasing public concern among policy-makers, healthcare providers and experts. Medical errors are repeated constantly, as in life occur. Most medical errors have less likely to cause damage, but some of them can lead to irreparable damage. [4] Medical errors are an inevitable part of the results of human performance. Errors investigation as a source of information about the health of an organization can be a good experience to improve patient safety. [5] According to official Starfield [1],[3] and the American Institute of Medicine (IOM), medical errors in U.S. hospitals and healthcare institutions are the third leading cause of death and nearly 98,000 annual deaths occur due to medical errors in hospitals. [3] In this paper, we defined each of medical errors, discussed information technology's role and its effect on reducing and preventing medical errors, present each technology advantage, and finally, recommended solutions to reduce medical errors in healthcare organizations.


  Materials and Methods Top


This review was conducted using the resources of the library, using websites and search engines and manually search. Scientific databases and electronic journal citations were searched to identify articles that discussed the role of health information technology in reducing preventable medical errors and improving patient safety. We used reference tracking and citation methods and searched by using the following keywords: information technology, medical errors, computerized provider order entry (CPOE), and clinical decision support system (CDSS). A total of 33 related articles were included in this study from 609 articles initially obtained from the searches. First, we collected and presented various types of medical errors from the viewpoints of the authors and organizations. Then, we discussed a variety of software and technologies used based on their importance and practical roles.


  Results Top


In November 1991, when the American Institute of Medicine (IOM) in its annual report cited the deaths of 98,000 people and more than one million injuries caused by medical errors, it was a great shock to the community and government and health sector policy-makers in the U.S. in regards to tracking and reducing medical errors. [1],[6] In the health and medicine area, all errors have extreme importance. [7] In fact, errors are events in acting and performance which conclude as follows: "They are threats to the welfare and health of the patient and should not occur. I do not want this to happen again, because it changes the quality of care provided". Medical errors are quite repetitive as happens in life. Most medical errors are less likely to hurt, but some of them lead to irreparable losses and heavy consequences. [8]

Widespread recognition of the importance of medical errors leads to innovative policies in the United States, Britain and other countries. While many medical errors are detected and corrected by human knowledge, these are weak strategies to reduce errors. [9] In hospitals, preventable errors are greater than deaths caused by traffic accidents, breast cancer and AIDS, which makes it a more important issue. [4] Most errors that occur during healthcare delivery include: medication errors, incorrect transfusion, nosocomial infections, surgical complications, mistaken surgeries, burns, fainting, falls, bedsores and incorrect patient identifiers. [3],[4] More serious complications occur due to more severe errors in the intensive care unit, operation room and emergency department. Diagram 1 shows details of the different types of medical errors. Medication errors are also divided into four categories: transcribing, dispensing, administration, and prescribing which can have errors such as wrong dose, wrong route or wrong timing [Figure 1]. [4]
Figure 1: Types of medical errors in healthcare organizations

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Studies show that a variety of technologies reduce medical errors, especially medication errors, and prevent them in the healthcare system that we describe as following:

Computerized provider order enter

It is a system where providers can enter care orders online in it. In fact, CPOE is a type of computer-based system which distributes and divides the common features by mechanizing the drug prescription process and provides a readable, accurate and standard instruction. [10] CPOE has the greatest impact on reducing medication errors as it reduces errors by as much as up to 83%. [10] This system improves provider order entry by ensureing legible, complete and accurate orders as much as possible. Also, it assists providers by presenting the relevant laboratory results, alerting allergies, drug-drug intervention, and experimental interventions; suggesting a proper dose and appropriate sequencing of medications for prescription. [2],[10],[11] Several studies have discussed the role and effectiveness of CPOE in different sectors of healthcare organizations and some of these roles and its effects include:

  • It provides reminders to include aspirin in coronary artery diseases, flu vaccine, and subcutaneous heparin. [12]
  • It doubles the utility of monitoring drug levels. [12]
  • It reduces the excessive use of antibiotics and diagnostic tests. [12],[13]
  • It sorts out the radiology and laboratory tests. [14]
  • In order to ensure safe use of the medications, CPOE suggests specific doses for each patient; provides reminders to monitor drug levels; controls drug allergies and drug interventions; increases legibility; communicates with the departments of nursing, radiology, laboratory, nutrition and pharmacy; and provides easy access to patient data and drug references. [15]
  • It has reduced the average patient length of stay from 12.9 days to 10 days in ICU. [12]
  • It has cut inpatients' costs up to 12.7%. [13]
  • It assists physicians in designing an appropriate treatment regimen. [16]
  • It constructs all orders and determines dose, route and frequency of drugs. [16]
  • It identifies prescribers in all cases. [17]
  • It provides information to prescribers in each step. [18]
  • It controls all the orders with the patient's problem list; such as allergies, medication interventions, higher doses, side effects and whether or not it is an appropriate dose for kidney and liver. [17],[19]


Clinical decision support system

Almost half of all medical errors associate with incomplete information about the patients and the drugs. CDSS provides clinical knowledge and information related to the patient to clinicians. CDSS selects them intelligently and displays it at the proper time. The information integrates the computerized patient records with the complete data repository accurately. [19] Improving the healthcare organization's performance through computer-based clinical decision support systems, is the common use of information technology in the health area. If these systems are used appropriately, major benefits will accrue such as better planning, cost reduction, reducing medical errors and quality improvement. [20]

In fact, CDSS is a software that provides information for safe health care. This information includes evidence-based standards and guidance; procedures and protocols; rules and recommendations for care; drug reference and tools to calculate drugs; links to library databases; and reference e-books and online references. [19] The system offers reminders to use care standards such as preventative care about RH before delivery; or alerts users about the risks (like allergies, lab tests such as platelet count). [21] Studies have shown the capabilities of the system and the most important ones are:

  • CDSS reduces serious medication errors and total medication errors by 55% and 83%, respectively. [22]
  • This system reduces the adverse effects of antibiotics and reduces costs. [23]
  • It reduces nosocomial infection rate. [11]
  • It warns physicians about problems that have not occurred at the same time.
  • It allows taking particular care of particular patients.
  • It instructs about the effective usage of the drugs.
  • It communicates pharmaceutical management.
  • It improves reporting and tracking of adverse drug effects
  • It uses standard electronic forms. [24]


Barcode medication administration

Moving towards electronic health records has raised the need to use standard barcodes in health care. Following the 1999 IOM report, as part of increasing efforts to improve patient safety, FDA announced that the existence of barcode labels for drugs and biological productions will be mandatory until 2006. FDA predicted that this will prevent the occurrence of nearly 500,000 adverse effects of medications and injection errors, over the next 20 years. Subsequently, VHA used BCMA software (Barcode technology, computers and networks are bound together) for the first time. [25] In this mechanism, each patient will receive a barcoded wristband containing information of identification after admission. New medication orders are entered electronically into the system. Nursing and pharmacy departments immediately see this information. The pharmacist checks all orders for allergies, drug interactions and dosage errors. He prepares a package of prescribed medications, installs the barcode label on them and sends it to the nurse. The nurse scans the medication label to confirm the dosage and type of medication and also scans the patient's wristband to manage medications. [24] In this system it is possible to reduce medication errors by ensuring all five stages of the medication management process: right patient, right drug, right dose, right route, and right time. [25] This technology is used in hospitals for medication management, patient safety improvement, documentation improvement, rapid preparation of a patient's bill and reduction in medical errors.

The studies show that this system can reduce medication errors as follows:

  • Reducing medication prescribing errors by 75.47%
  • Reducing distribution errors of medications prescribed for the patient by 70.34%
  • Reducing medication administration time errors by 87.41%
  • Reducing inpatient errors by 93.48%
  • Reducing incorrect doses prescribed by 61.97%. [26]


Radio frequency identification

Most automatic identification systems increase efficiency, reduce data entry errors, allow staff to spend more time for important tasks, such as better customer service. Various technologies have been designed and implemented for automatic identification; such as bar codes, smart cards, voice recognition, some biometric technologies, optical character recognition, and radio frequency identification.

The RFID technology is used to improve the retrieval of medical records, identifying and monitoring patients, financial transactions, drug delivery and compliance with the patient's condition, medicines authenticity and tracking, facilitating drugs, the work of physicians and other staff, staff management, and many others related to the health area.

Wireless sensor network

Recent advances in electronics and wireless telecommunications have created the ability to design and build sensors with low power consumption, small size, reasonable price for various uses. These tiny sensors that have the ability to perform such as environmental information capturing based on sensor type and processing and sending the details, gave rise to an idea to develop and expand wireless sensor networks. Advances in wireless sensor networks, provides new opportunities for healthcare systems and to monitor the disable patients, medication management in hospitals, and to track and monitor the movement of patients. In factories producing chemicals and pharmaceuticals, sensor networks monitor medication combination rates, because the slightest error can pose a risk to the lives of thousands of people. We can use the wireless sensors to monitor users who are employed. Also, wireless sensor networks are used in health issues in cases such as gathering data on the physical, psychological, psychiatric, cognitive and behavioral processes; finding patients and doctors in medical environments; and managing medications in hospitals. WSN has revolutionized health care by preparing continuous, non-invasive and low cost ambulatory care as well as updating medical records via the internet.

Electronic health record

In today's world, the biggest challenges is providing the integrated healthcare services and access to patient information by healthcare team members in a timely and reliable manner. EHR is available in each place for different people and at the same time as well as instant information retrieval is done. [26]

EHR collects health information throughout a person's lifetime electronically. The information is transmitted and maintained securely. In fact, EHR includes all of the information related to the health of a person's life such as experiments, interpretations, plans, procedures, allergies, diseases and injuries, evaluations, immunization data, behavioral, environmental, demographic, legal and administrative data. [27] The main advantages of EHR include: Offers medical reminders and warnings; [24],[26],[28] connects clinicians to the protocols, care plans, critical pathways, databases, medications information, and other healthcare knowledge databases; detects abnormal test results and threatening drug interactions; detects errors and adverse effects through the integration of multiple information sources (lab, pharmacy and radiology). [5],[9]


  Discussion Top


The nature of medical errors occurs in organizations as errors in drug administration, treatment, actions, diagnoses and administrative tasks. Among the systems and technologies that are available to prevent and reduce medical errors, CPOE, CDSS and EHR are better known. The most technologies reduce medical, administrative and diagnostic errors. [29]

The studies have shown that CPOE, RFID, CDSS and EHR are more effectively than other technologies in error reduction, quality improvement, and care efficiency. CPOE integration with CDSS more likely reduces medical and medication errors. CPOE solves the problems of health care (low use, wrong use and overuse). EHR provides clinical reminders and warnings and intelligence capabilities; increases the effectiveness of health care; and reduces medical errors. CPOE has the greatest effect in reducing medication errors. The BCMA is more effective in medication management. Also, EHR has a more prominent role in the recovery of the patients with chronic diseases such as diabetes and asthma that frequently receive multiple services from various specialists. Furthermore, CDSS recognizes the adverse effects of drugs and medication errors which were more difficult to detect.


  Conclusion Top


Generally, information technology improves healthcare system, regardless of the type of technology used, by one of the followings: documentation (test results, clinical reports, recommendations and consultation), and providing communication between the patient and each other providers, facilitating data entry, identification and evaluation of risks. [30]

We recommend increasing healthcare providers' knowledge about medical errors and drugs adverse effects as well as increasing patients' and their families' knowledge about medication administration. Also, prescription documenting be standardized using the full drug name and route of drug entry into the body. Furthermore, a comprehensive list of the benefits and role of impact of technologies on reducing medical errors and increasing patient safety to be provided and the most effective ones to be localized as well as redesigning the workflows. [31],[32]

 
  References Top

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2.Anderson JG, Jay SJ, Anderson M, Hunt TJ. Evaluating the capability of information technology to prevent adverse drug events: A computer simulation approach. J Am Med Inform Assoc 2002;9:479-90.  Back to cited text no. 2
    
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