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Discussion on Medical Errors as the 3rd Most Common Cause of Death

Posted on May 9, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Social media and mainstream media is abuzz with this article in BMJ by Martin A Makary and Michael Daniel entitled “Medical error—the third leading cause of death in the US.” This image summarizes the headlines most people wrote:

Medical Errors and Leading Cause of Death in US

While this makes for a great headline, most of the journalists and those in the media evaluating the BMJ article do like they usually do and run the headline without actually digging into the details of the study itself. Lucky for us, David Gorski, has published a really great analysis of the article on the Science-Based Medicine blog. I won’t summarize it here, since you should go and read David’s article in full. We’ll be here when you get back.

What everyone acknowledges is that medical errors take the lives of many in the US Health System. In fact, it happens in every health system. What’s also clear from this discussion is that there are A LOT of complexities associated with how you define when a death was caused by medical error, what is defined as a medical error, etc etc etc. David’s article above finishes with this summary on the importance of patient safety and decreasing death due to medical errors which is the point I think we should take from it all:

Over the last three years, I’ve learned for myself from firsthand experience just how difficult it is to improve the quality of patient care. I’ve also learned from firsthand experience that nowhere near all adverse outcomes are due to negligence or error on the part of physicians and nurses. None of this is to say that every effort shouldn’t be made to improve patient safety. Absolutely that should be a top health care policy priority. It’s an effort that will require the rigorous application of science-based medicine on top of expenditures to make changes in the health care system, as well as agreement on exactly how to define and measure medical errors. After all, one death due to medical error is too much, and even if the number is “only” 20,000 that is still too high and needs urgent attention to be brought down. Unfortunately, I also know that, human systems being what they are, the rate will never be reduced to zero. That shouldn’t stop us from trying to make that number as close to zero as we can.

Unfortunately, I believe that false headlines with inflated numbers don’t help us understand the real problem and address it. The inflated numbers from the so called “study” just cause us to confuse the issues. The numbers really don’t pass the “smell test” on a number of levels. Not the least of which, from my perspective, is that we don’t have more medical malpractice lawsuits. In this sue happy society, if there were 251k deaths due to medical error, we’d have many more medical malpractice lawsuits out there. David explains a bunch more reasons why the numbers don’t make sense and why they’re really hard to calculate, so go and read those if you want a more detailed analysis.

Gong back to the earlier quote. Even if the number was 20,000, that’s still far too many. We know medical errors cause death and we should work hard to prevent that from happening. Since I write from a tech perspective, I’m interested in thinking about how technology could impact these medical error rates.

From a tech perspective, I always find it interesting to read stories about the way EHR software can help prevent medical errors. The basic analysis usually points to things like drug to drug interaction checking, drug to allergy interaction checking, and other clinical decision support tools. No doubt simple checks like this can have an impact on the number of medical errors in a healthcare organization. We’ll leave the discussions of alert fatigue for another discussion.

Very few people would argue against the concept that having the right information at the right time will help doctors and nurses reduce medical errors. Ideally, that’s what technology should help facilitate. Plus, technology should help analyze massive amounts of health data (both personal and general) in order to facilitate the provider in their care of the patient. In many cases, that’s exactly what technology can and does do for healthcare. However, we’re not living in an ideal world. Technology can also increase the number of medical errors when implemented poorly or improperly.

In some cases, EHR software perpetuates misinformation and leads to providers having the wrong information at the wrong time. Sometimes the clinical decision support algorithms fail. I could go on and on about the potential issues. These are a problem and now that EHR software is a major part of most health systems, we’re going to see the number of medical errors due to EHR software increase. However, in doing so, we shouldn’t forget that paper had its own medical error issues as well.

Another major cause of medical errors related to EHR software is when providers create an over reliance on the software for clinical decision making. This concern is often couched as “new doctors don’t know how to see patients without an EHR.” I think this concern only partially explains the risk of medical errors that we could experience if we’re not careful with our over reliance on technology in the care we provide patients.

Just this weekend I had this experience in my own personal life. We were headed to a new restaurant on Saturday night. We plugged the address into the GPS and started following the instructions it gave us to get to the restaurant. After turning into an apartment complex, we knew that we’d relied a little too much on technology and it had led us astray.

The banter between my wife and I was telling. As the GPS told us to turn into the apartment complex I told my wife that something didn’t feel right about these directions. My wife told me that it said to turn there. It was easy for me to succumb to my wife’s reliance on technology and not follow my own intuition and experience to navigate us a better direction.

In my wife and I’s case, nothing too serious was on the line (although the kids were getting antsy in the back of the car). Sure, it took us about 5 more minutes to get to the restaurant, but we made it without any major harm. The same isn’t true in healthcare where if providers aren’t careful, their over reliance on technology can cause medical errors that could even lead to loss of life. Plus, group think about technologies ability (or inabilities) can also cause trouble.

Like most things in life, we can take any of these approaches too far. We can’t be irrational about any specific approach since these are complex problems which require a detailed approach to understanding and mitigating their impact. Sometimes technology can be the solution to medical errors, but it can also be the problem if we’re not careful. It always takes the right balance to make sure we’re reducing medical errors as much as possible while not causing new ones.

Highly Functional EMRs Aren’t Necessarily High-Functioning

Posted on July 28, 2011 I Written By

I’ve just turned in a story for InformationWeek Healthcare about the new “Essentials of the U.S. Hospital IT Market, 6th Edition” report from HIMSS Analytics. That report details the progress hospitals and integrated delivery networks have made in IT over the past year and gives an update on how far along providers are according to the HIMSS Analytics EMR Adoption Model. That’s the seven-level scale (eight if you count Stage Zero) that measures adoption of various EMR components.

At the top of the scale, 1 percent of nonfederal hospitals in the U.S. attained Stage 7 in 2010, meaning that the EMR served as the legal medical record for all departments, was capable of exporting patient records as Continuity of Care Documents and had data warehousing and mining in place. That was up from 0.7 percent in 2009. The number of Stage 6 hospitals—with electronic clinician documentation, full clinical decision support and full PACS for radiology—doubled in the same time frame, from 1.8 percent in 2009 to 3.2 percent in 2010.

Here’s how the entire scale breaks down:

 

Actually, the EMRAM Web page shows newer numbers, through the 2011 second quarter. We’re up to 1.1 percent for Stage 7, 4 percent for Stage 6, 6.1 percent for Stage 5 and 12.3 percent for Stage 4. HIMSS considers Stage 4 to be the closest to the current requirements for “meaningful use” of EMRs.

It’s nice to see progress in installing technology and it’s nice to see hospitals using EMRs in a “meaningful” way, but that doesn’t mean there won’t be problems. As everyone in health IT knows, EMR certification, a prerequisite for meaningful use, does not measure usability, and this still is the first of three stages for meaningful use. That means we’re a long way from perfect, or even ideal. How do I know this?

The mother of a good friend of mine is now on dialysis and eventually will need a kidney transplant because she was given a medication that is contraindicated for Type 2 diabetes, which she suffers from. The harmful interaction resulted in her losing about 80 percent of normal kidney function. This happened at a HIMSS Analytics EMRAM Stage 7 hospital. Apparently, either the patient record didn’t show she was diabetic, the medication order didn’t get flagged, or the ordering physician, pharmacy and administering nurse all missed or ignored an alert. As the chart above illustrates, the medication loop should have been closed by Stage 5.

I’m not going to name the hospital or give any more details because there’s a good chance a malpractice suit is coming. I’m also aware of a medical informaticist with a long history of implementing and working with EMRs losing his mother due to a medical error that an EMR exacerbated. Again, I’ve been asked not to say more because of the legal ramifications.

It’s no secret that healthcare is in trouble. In this push to install technology and earn Medicare and Medicaid bonuses for meaningful use, we can’t take our eyes off the ultimate goal, creating a safer health system.

Obama’s Assumptions Related to Health Care IT Investment

Posted on February 11, 2009 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve been thinking a lot about the legislation that’s about to hit the fan in regards to investment in healthcare IT and in particular EHR and EMR softare. My biggest fear in this whole process is that the underlying assumptions being made will turn out to be wrong.

The following is a list of assumptions I’ve seen made in regards to the government’s investment in healthcare IT and EHR and its possible benefits. I’ll also offer a few comments on each assumption for people to consider.

Cost savings – The largest savings I’ve seen a medical practice receive from EHR implementation is in saved transcription costs. There’s some small savings from charting supplies and the like. Otherwise, where are the cost savings occurring? My guess is that if you polled those using an EHR you’d find very few cost savings. You would however find a number of new costs related to investment in technology. There must be some long term cost savings that the government sees that I’m missing.

Cut waste – I guess this has some minimal “Green” benefit. It just seems rather minimal to me.

Reduce the need to repeat expensive medical tests – I can’t wait for this benefit to be realized. Unfortunately, I’m afraid that the technology and more significantly the policies are in place to make this happen. Long term this benefit will be awesome, but we’re so far from realizing it that it’s hard for me to use this as a strong justification for the investment.

Save jobs – Health care has been relatively immune to lost jobs, but this investment will help save some jobs. We’ll just have to see if the money ends up going to big EHR companies who will just get richer in the process or whether this investment will do something significant in regards to saving and creating jobs.

Save lives by reducing the deadly but preventable medical errors that pervade our health care system – I’ve seen far too many research articles on both sides of this argument. Some say it helps prevent medical errors and others suggest that it may cause other errors. I’m not sure which way to think on this. In a perfect world it would certainly prevent medical errors. Unfortunately, a computer can only think so much. I’m afraid that an EHR isn’t the secret elixir we’d all hoped to use to solve medical errors.

I’m sure that I’ve missed other reasons. Feel free to add comments and other reasons I’ve missed in the comments.

I think I better work on a follow up article on the reasons why Obama should invest in health care IT. I think there are good reasons to invest in this area. Otherwise, I wouldn’t be writing about the subject. However, I think it’s interesting and valuable to have a realistic picture of why EHR implementation is important. I really am an EHR and EMR optimist.