Term Paper: Addressing the Issue of Medical Errors With Mandatory Reporting Systems and Computer Technology

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Healthcare: Addressing the Issue of Medical Errors

Healthcare

Addressing the Issue of Medical Errors with Mandatory

Reporting Systems and Computer Technology

To combat the current crisis of deaths due to preventable medical errors the health care industry and lawmakers have taken two approaches. The first is the implementation of a system of mandatory reporting systems. The solution is to crate an atmosphere in hospitals that fosters less blame, not more, according to the IOM report. A blue-ribbon pane appointed by the IOM argues that the failure to acknowledge and analyze mistakes deprives hospitals of important information that could help prevent similar mistakes in the future. However, many in the healthcare industry argue that mandatory reporting of errors will foster an atmosphere of lawsuits and backlash by the public. The end results would be increased costs, higher insurance premiums, and an overall distrust of hospitals and other healthcare facilities. The Joint Commission states that it is fully supportive of creating an effective health and medical care error reporting system either voluntary or mandatory with characteristics expressed in events to be reported to the system be well defined. If the system is one that is Mandatory then the system should be limited to serious adverse events. . The fears of improper disclosure have been shown to be barrier or challenge as well as funding due to lack of federal funding for these programs however, due to the lack of legislation in this area these programs are vital for implementation to ensure patient safety in the future.

- Healthcare

Addressing the Issue of Medical Errors with Mandatory

Reporting Systems and Computer Technology

Table of Contents

Abstract

1

Introduction

3

Medical Errors Background Information

6

Stakeholders

10

Type of Errors

10

Mandatory Reporting Systems

13

Challenges

14

Legal Protection of Error Information

14

Public Disclosure of Errors

16

Legislation

18

Patient Involvement

25

Recommended Guidelines

27

Elements Impacting Mandatory Reporting Costs

30

The Mandatory System at Work: Florida & NY

31

Use and Analysis of Data: Florida

32

Use and Analysis of Data: New York

32

Cost Analysis of Reporting Programs

34

Summary and Conclusion

39

- Healthcare

Addressing the Issue of Medical Errors with Mandatory

Reporting Systems and Computer Technology

Introduction

Experts have known for some time the medical errors are widespread and have been for over a decade. However, the problem has not received a new dose of attention from the public and Congress following a recent report from the prestigious Institute of Medicine (IOM) giving confirmation to the extent of the phenomenon and urging reforms. In fact, more people die each year due to preventable medical mistakes in American hospitals than are killed in car crashes or by breast cancer or AIDS. To combat the current crisis of deaths due to preventable medical errors the health care industry and lawmakers have taken two approaches. The first is the implementation of a system of mandatory reporting systems.

The solution is to crate an atmosphere in hospitals that fosters less blame, not more, according to the IOM report. A blue-ribbon pane appointed by the IOM argues that the failure to acknowledge and analyze mistakes deprives hospitals of important information that could help prevent similar mistakes in the future. However, many in the healthcare industry argue that mandatory reporting of errors will foster an atmosphere of lawsuits and backlash by the public. The end results would be increased costs, higher insurance premiums, and an overall distrust of hospitals and other healthcare facilities.

On the other hand, current research evidence shows that when compared to paper-based systems, the optimal solutions for the prevention of medical errors are high-tech in nature. When implemented these solutions show marked reduction in all types of medical errors. The success of any rollout involving new hardware and software hinges on the collaborative and effort building between IT managers and the company employees. Possession of the high-end technology in itself alone without the willingness of the end-users to undergo proper training and then followed by a sincere effort to properly use the newly installed computer information systems. Likewise the IT management teams must access end-user needs as well as incorporating their suggestions into the finalized decision in the process. When these situations exist simultaneously with the end result being that of achievement.

Because we are in a computer/digital age coupled with the fact that healthcare organizations are trying to reduce or eliminate medical errors with alternative solutions, an in-depth discussion of high-techs options is highly relevant for hospital administrators and IT management to consider. This is specifically the case when uses of these systems reduce error rates dramatically; thereby positively affecting the health care patients receive. In addition, a net effect of reduction in heath care costs cannot be over looked. Today these pressing issues of are of an immense proportion to all American as the healthcare systems in the U.S. is poised to undergo significant changes in the near future." With the recent YIPA legislation, possible privatization of Medicare, new innovations including Wi-Fi Internet access, mobile computing, remote access and a never ending quest to eliminate costs, hospital IT management must always be cognizant of new technology as it materializes.

When making examination of the successful introduction and final adoption of high-tech solutions into the health care system, one must review the whole picture before and after implementation. By studying the overall characteristics of an organization, assumptions can then be made as to why certain applications are readily accepted while others are not. Also the same reasoning can be applied to the assessment of why particular departments within healthcare institutions welcome change while others resist at every step along the process of upgrading. Common areas of interests include the following:

Educational background of employees to be affected by the new computer system

Attitudes, perception, and biases toward computer technology

Educational background of employees to be affected by the computer systems.

Level of communications between different departments

Relationship between upper management, IT Personnel, and end users.

The extent of the problems leading to medical errors

Employee training and evaluations

The Technologies (hardware and software)

Medical Errors: Background information

Type of Errors

There are several types of medical errors and each of these may be inclusive in the category of "Diagnostic," "Treatment," "Preventative," or "Other."

Diagnostic

Error or delay in diagnosis

Failure to employ indicated tests

Use of outmoded tests or therapy

Failure to act on results of monitoring or testing

Treatment

Error in the performance of an operation, procedure, or test

Error in administering the treatment

Error in the dose or method of using a drug

Avoidable delay in treatment or in responding to an abnormal test

Inappropriate (not indicated) care

Preventative

Failure to provide prophylactic treatment

Inadequate monitoring or follow-up treatment

Preventative

Failure to provide prophylactic treatment

Inadequate monitoring or follow-up treatment

Other

Failure of communication

Equipment failure

Other system failure

The extremely complex issues associated with health care reporting systems demand critical examination before implementation of a system. Healthcare systems serve two main purposes, which are:

1.

Holding professionals accountable for their performance

2.

Improving Patient Safety

In a study conducted at Columbia University focused on the subject of medical errors the five search terms utilized as those of 'mistake', 'error', 'incorrect', 'inadvertent' and 'iatrogenic in the surveying of sets of multiple reports that are in the nature of a narration. The stated goals of the study are:

1) Measure the rate at which medical errors were documented in medical records; and

2) Characterize the types of errors that were identified.

Discovered were 222 medical errors in 286,000 discharge summaries from 1991-2000, 9 medical errors in 48,000 outpatient notes and 11 medical errors in 49.500 sign out notes. Keyword searches are stated to have "detected a broad range of errors, including medication, diagnosis, surgery, service, and administration error. The most common of the documented error were those that were 'therapeutic-related. The errors that were termed 'therapeutic errors were for the most part those which were of the nature of medication related errors. The errors were found throughout all four stages in the drug ordering and delivering system, which are:

Physician Ordering

Transcription and Verification

Pharmacy dispensing and delivery, and Nurse and Administration

Narrowing the category further, of those errors that were medication related the two main errors were those of:

Wrong dosage

Wrong Frequency

Wrong Drug Use

The breakdown of sections of discharge summaries revealed the following information in the chart below labeled Chart 2.0

Chart 2.0

Detected Medical Errors

Detected in the section "hospital course"(62.2%)

53

Detected in the section "history of present illness" (23.9%)

31

Detected elsewhere (14.0%)

67% of 'new' errors were reported in the "History Course"

75% percent of old errors are reported in the "History of Present Illness"

Implications of the study were that: "Voluntary reporting and mandatory reporting systems play a valuable role in error detection and are in widespread use." Nevertheless the systems reportedly, "miss most errors and adverse events, and usually have poor physician participation." Furthermore the reports have omitted details… [END OF PREVIEW]

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