NEJM: EHRs should offer adverse event reporting
Adverse event reporting systems have only negligibly improved healthcare since the 1999 release of the IOM report "To Err is Human," wrote the authors of a New England Journal of Medicine perspective published Nov. 10—but, they said, healthcare could be improved by harnessing data and measuring adverse events using EHRs.
Ashish K. Jha, MD, of the Harvard School of Public Health and VA Boston Healthcare System, and David C. Classen, MD, of the Computer Sciences Corporation and the University of Utah, pointed to recent articles that reported little to no progress in patient care with relation to adverse events.
Among them, Landrigan et al found rates of injury due to medical errors remained almost unchanged between 2000 and 2008 at 10 North Carolina hospitals, and a report from the Inspector General of the U.S. Department of Health and Human Services found that Medicare patients experienced substantial harm in hospitals as recently as 2008 (N Engl J Med 2004;351:1838-1848). Additionally, Classen and colleagues found nearly one third of patients are harmed during a hospital stay, and adverse event reporting underestimates the frequency.
“If the United States has made progress in patient safety, it has been inadequate,” the authors wrote.
Progress has been insufficient due to the lack of a robust measurement program, according to Jha and Classen, but if meaningful use requirements were to include adverse event reporting, EHRs could be promising.
“EHRs can systematically measure patient safety, turning a laborious, manually intensive and expensive process of sifting through medical records to identify adverse events into an automated one that is efficient, consistent, and affordable,” the authors wrote. “Although the technology is already available, most EHRs today are not built with this capability in mind—and it won’t be easy (or cheap) to retrofit EHR systems later.”
Jha and Classen recommended that the federal government include the ability to measure and report adverse events as a core requirement of meaningful use. Such an effort would encourage vendors to implement adverse event reporting systems in EHRs, which in turn could provide hospitals and healthcare professional with information on the effectiveness of their safety interventions and data to compare with other organizations.
"By making systematic measurement of adverse events a requisite function of the EHRs that are eligible for financial incentives, the federal government can change the way safety is measured and improved throughout the healthcare system. Without these data, we are likely to repeat our recent experience: good intentions, a lot of effort, and little demonstrable effect,” concluded Jha and Classen. “According to IOM estimates, as many as a million Americans may have died owing to adverse events in U.S. hospitals over the past decade. We must do better over the next decade. EHRs can improve the safety and culture of U.S. healthcare, but only if the federal government, as the nation’s largest payor, demonstrates that it is serious about improving patient safety.”
Ashish K. Jha, MD, of the Harvard School of Public Health and VA Boston Healthcare System, and David C. Classen, MD, of the Computer Sciences Corporation and the University of Utah, pointed to recent articles that reported little to no progress in patient care with relation to adverse events.
Among them, Landrigan et al found rates of injury due to medical errors remained almost unchanged between 2000 and 2008 at 10 North Carolina hospitals, and a report from the Inspector General of the U.S. Department of Health and Human Services found that Medicare patients experienced substantial harm in hospitals as recently as 2008 (N Engl J Med 2004;351:1838-1848). Additionally, Classen and colleagues found nearly one third of patients are harmed during a hospital stay, and adverse event reporting underestimates the frequency.
“If the United States has made progress in patient safety, it has been inadequate,” the authors wrote.
Progress has been insufficient due to the lack of a robust measurement program, according to Jha and Classen, but if meaningful use requirements were to include adverse event reporting, EHRs could be promising.
“EHRs can systematically measure patient safety, turning a laborious, manually intensive and expensive process of sifting through medical records to identify adverse events into an automated one that is efficient, consistent, and affordable,” the authors wrote. “Although the technology is already available, most EHRs today are not built with this capability in mind—and it won’t be easy (or cheap) to retrofit EHR systems later.”
Jha and Classen recommended that the federal government include the ability to measure and report adverse events as a core requirement of meaningful use. Such an effort would encourage vendors to implement adverse event reporting systems in EHRs, which in turn could provide hospitals and healthcare professional with information on the effectiveness of their safety interventions and data to compare with other organizations.
"By making systematic measurement of adverse events a requisite function of the EHRs that are eligible for financial incentives, the federal government can change the way safety is measured and improved throughout the healthcare system. Without these data, we are likely to repeat our recent experience: good intentions, a lot of effort, and little demonstrable effect,” concluded Jha and Classen. “According to IOM estimates, as many as a million Americans may have died owing to adverse events in U.S. hospitals over the past decade. We must do better over the next decade. EHRs can improve the safety and culture of U.S. healthcare, but only if the federal government, as the nation’s largest payor, demonstrates that it is serious about improving patient safety.”