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National Summit on Medical Errors and Patient Safety Research
Additional Statement, Submitted by Dr. Neil Baum, Urologist, New Orleans, LA The first National Summit on Medical Errors and Patient Safety Research was held on September 11, 2000, in Washington, DC. Sponsored by the Quality Interagency Coordination Task Force (QuIC), the Summit’s goal was to review the information needs of individuals involved in reducing medical errors and improving patient safety. More importantly, the summit set a coordinated and usable research agenda for the future to answer these identified needs. Selected applicants testified at the summit as members of the witness panels. The remainder of the applicants were invited to submit additional statements for consideration by the steering committee. One of these statements follows. Disclaimer and Copyright Statements Experts estimate that more than $500 billion in annual healthcare costs is spent on unnecessary clinical care and administration-time and money better spent on providing improved care.1 In addition to the economic costs of inefficiency, miscommunication among healthcare professionals and missing information can pose significant risks to a patient’s health and to a provider’s credibility. For example, adverse drug events (ADEs)) affect an estimated 1.3 million Americans every year.2 ADEs are frequently caused by written and verbal miscommunication among doctors, pharmacists and administrative staff. A recent Journal of the American Medical Association study found that when physicians prescribed electronically, the rate of ADEs was reduced by 55%,3 and yet less than one percent of the three billion annual U.S. prescriptions is written electronically. New technology now available from ePhysician (Mountain View, California, www.ePhysician.com) uses a handheld computer in the exam room, on hospital rounds, and even at home or hundreds of miles from your office. The program allows the physician to order prescriptions and lab tests in real time or while the physician is eyeball to eyeball with the patient. The information is transmitted by connecting to a personal computer or by a wireless handheld device. The data is sent to the ePhysician server via a quick and secure Internet connection. After the information is rapidly processed and checked for a variety of potential conflicts such as drug interactions, the ePhysician server sends information such as prescription or lab work orders to the pharmacist or laboratory of choice, either electronically or by FAX. By automating these tasks, ePhysician makes the medical practice more efficient. ePhysician allows doctors to eliminate conflicts arising from illegible handwriting. A recent case in Texas resulted in $450,000 award to a patient’s family when the doctor was found negligent and a cause of the patient’s death due to poor handwriting on a prescription that was filled incorrectly. (See Figure 1. where the doctor intended "Isordil" but the pharmacist filled it as "Plendil"). The prescription was supposed to be for 20mg Isordil every six hours to treat the patient’s angina. Because the prescription was written poorly, the pharmacist provided the patient with Plendil, normally used to treat high blood pressure, at the 20mg every six hours dosage. The maximum daily dosage of Plendil is only 10mg. The patient suffered a fatal heart attack after taking the overdose of Plendil. Had the cardiologist had an ePhysician computer and program, this fatal error would probably not have happened. Since ePhysician's data is continuously updated via the Web, doctors can rely on the system for the most current information available regarding formularies. This immediate access to this data can be particularly useful in reducing the number of calls from pharmacies to resolve formulary conflicts, which doctors report reaches up to 20 per day.4 HMOs cover 67 million Americans and nearly 80 percent of all HMOs use formularies.5 The program also identifies drug interactions, drug allergies and disease compatibility. For example if a patient is taking nitroglycerin and a prescription is inadvertently written for sildenafil (Viagra), the program will identify this drug interaction and the prescription will not be filled. This inefficiency is largely due to a lack of communication among physicians, hospitals, payors, hospitals, and pharmacies. Our profession also suffers from the inability to access critical patient care information residing in paper records in multiple locations. Information that could facilitate medical decision-making, such as drug formation, disease management protocols or treatment guidelines, is not available to physicians when they we see our patients. The only information available to doctors as we make our medical decisions resides in paper records, our own memory and in the patient's memory. This deficiency of access to relevant information at the point of care results in unnecessary procedures, drug interactions, and an administrative burden all of which contribute directly to unneeded costs. The ePhysician operates on the hand-held Palm Top computer and requires a PC with a CD ROM drive and an Internet connection (AOL, Prodigy or POL are not recommended) with a minimum modem speed of 56K and a digital subscriber line (DSL) for optimum performance. The PC requires a Pentium II with 366MHz or better, 99MB of available hard disk space, and 64MB of RAM. The program is available on a CD and can be easily integrated with many existing practice management systems including practice management systems including Medical Manager, Lytec, Stratford, Medic, and Medisoft. The program can also support multiple providers within the same practice or office. Physicians have to strive to ensure that patients have a positive health care experience by providing seamless delivery of outstanding, stellar health care, using technology to enhance patient satisfaction and making an effort to give patients the educational material and information that they are so eager to have. By consolidating common activities such writing prescription and ordering lab work on a mobile, Internet-ready computing platform, ePhysician allows doctors to spend more time with tier patients and make each patient visit more productive. If you simply avoid adding new technology to your practice, you are at risk to falling behind in these times of enhanced competition, and a struggle to improve the efficiency of your practice. ePhysician is one small click made by the physician, but one giant leap for patient satisfaction. ePhysician makes use of technology to give doctors what they need, when they need and where it is needed most, when the doctor is eyeball to eyeball with the patient, or at the point of care. Top of PageSources 1. University of Chicago.JAMA, April 1998 4. Schonfeld E. Can computers cure healthcare? Fortune. March 30, 1998. Top of PageCurrent as of September 2000 Internet Citation: Additional Statement by Neil Baum. National Summit on Medical Errors and Patient Safety Research. September 2000. http://www.quic.gov/summit/abaum.htm Return to Additional Statement Directory |