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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.

EMR & Patient Safety, Meaningful EHR Measures, and the Patient Portal “Switch”

Posted on January 20, 2013 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.


What an important topic of discussion. In fact, it makes me want to look at writing a whole series of articles on the patient safety issues using an EMR and also the patient safety issues of not using an EMR. Much of it I’ll be covering in my EHR benefits series, but quite a different angle. Although, the ethics side of it could be really interested. I’m glad Dr. Wes is starting this discussion.


I keep wishing it was interoperability, but I do think we could go way too far when it comes to adding more measures and end up with measures that provide little to no value if we’re not careful.


I love that people think that implementing a patient portal is as easy as flipping a switch. I can have a full EMR at my fingertips in 2 minutes by signing up at one of the Free EHR, but that misses so many important parts of implementing an EMR. The same goes for a portal. It takes a little more thought to implement a patient portal than just flipping a switch.

Top 10 Medical Technology Hazards List – “Top 10” Health IT List Series

Posted on December 29, 2011 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.

This next list I found in my series of Top Health IT lists is going to be one that I think surprises quite a few people. It’s the list (PDF) of Top 10 Technology Hazards for 2012 by the ECRI. The Power Your Practice website did an interview with James P. Keller Jr. who works at the ECRI Institute about this list which is worth reading. Before the interview, they explain that the ECRI (Emergency Care Research Institute) was created in 1964 after a young boy in a Philadelphia ER passed away as a result of an improperly preserved defibrillator.

For this list, I’m not planning to go through each item, but I will list each item:
1. Alarm hazards
2. Exposure hazards from radiation therapy and CT
3. Medication administration errors using infusion pumps
4. Cross-contamination from flexible endoscopes
5. Inattention to change management for medical device connectivity
6. Enteral feeding misconnections
7. Surgical fires
8. Needlesticks and other sharps injuries
9. Anesthesia hazards due to incomplete pre-use inspection
10. Poor usability of home-use medical devices

The PDF document above goes into a lot more detail for each of these items including suggestions on ways to prevent these problems. I imagine many hospital safety organizations already know about these things and lists like this one.

Many are probably wondering why I’m bringing this list up on an EMR and HIPAA website. Besides the fact that the list is interesting on its own, I was also really intrigued that there’s nothing on the list that’s even remotely related to EMR & EHR software.

I’m sure if we sat down for just a little bit we could think of quite a few technology hazards related to EMR and EHR software. Not the least of which is EHR down time. I’m also reminded of this post I did earlier this year titled “EMR Perpetuates Misinformation.” Yet, EHR didn’t make the list…yet(?).

It will be interesting to watch this health technology hazards list over time to see if EHR software ever makes the list. I wonder how many hospital patient safety groups are worried about the safety of EHR software. I’ll have to get Katherine Rourke to dig into this over on Hospital EMR and EHR.

Be sure to read the rest of my Health IT Top 10 as they’re posted.

Study Shows Value of NLP in Pinpointing Quality Defects

Posted on August 25, 2011 I Written By

For years, we’ve heard about how much clinical information is locked away in payer databases. Payers have offered to provide clinical summaries, electronic and otherwise, The problem is, it’s potentially inaccurate clinical information because it’s all based on billing claims. (Don’t believe me? Just ask “E-Patient” Dave de Bronkart.) It is for this reason that I don’t much trust “quality” ratings based on claims data.

Just how much of a difference there was between claims data and true clinical data hasn’t been so clear, though. Until today.

A paper just published online in the Journal of the American Medical Association found that searching EMRs with natural-language processing identified up to 12 times the number of pneumonia cases and twice the rate of kidney failure and sepsis as did searches based on billing codes—ironically called “patient safety indicators” in the study—for patients admitted for surgery at six VA hospitals. That means that hundreds of the nearly 3,000 patients whose were reviewed had postoperative complications that didn’t show up in quality and performance reports.

Just think of the implications of that as we move toward Accountable Care Organizations and outcomes-based reimbursement. If healthcare continues to rely on claims data for “quality” measurement, facilities that don’t take steps to prevent complications and reduce hospital-acquired infections could score just as high—and earn just as much bonus money—as those hospitals truly committed to patient safety. If so, quality rankings will remain false, subjective measures of true performance.

So how do we remedy this? It may not be so easy. As Cerner’s Dr. David McCallie told Bloomberg News, it will take a lot of reprogramming to embed natural-language search into existing EMRs, and doing so could, according to the Bloomberg story, “destabilize software systems” and necessitate a lot more training for physicians.

I’m no technical expert, so I don’t know how NLP could destabilize software. From a layman’s perspective, it almost sounds as if vendors don’t want to put the time and effort into redesigning their products. Could it be?

I suppose there is still a chance that HHS could require NLP in Stage 3 of meaningful use—it’s not gonna happen for Stage 2—but I’m sure vendors and providers alike will say it’s too difficult. They may even say there just isn’t enough evidence; this JAMA study certainly would have to be replicated and corroborated. But are you willing to take the chance that the hospital you visit for surgery doesn’t have any real incentive to take steps to prevent complications?

 

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.