Information Technology Reference
In-Depth Information
Among the most common and widely studied sources of error derives from
medication administration. According to The Commonwealth Fund the three lead-
ing causes of medication error are performance deficit (failure to act in accordance
with education and training), failure to follow a procedure or protocol, and inaccu-
rate or omitted transcription. [
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]
Improved Processes:
Remember that a key issue for the effective use of information
technology is to improve business processes. Ideally, process improvement should
be at the top of the reasons why electronic records are deployed. In practice, this is
usually not the case. The reasons relate to a lack of focus on process improvement in
the project planning and design, the design of the systems themselves and the way
they are implemented. Most systems are built around discrete transactions that take
place within a department or working group. Even though these may be part of an
overall business process that cuts across many or most of these groups, the overall
process is rarely built into EHR systems. Similarly, systems are often procured and
implemented without clear consideration of the overall business and its processes.
As a result, each workgroup or department may well optimize things for their needs
but the overall interests of the business may not be well recognized or effectively
served. This is a major reason why one of the leading concerns given about adopting
electronic records in the 2008 DesRoches physician EHR adoption survey [
5
] w a s
the lack of any clear return on investment and decreased productivity.
Clinical Decision Support:
When Larry Weed first proposed his structured medical
record his goal was to help physicians organize their work. [
6
] For the past few
decades his focus has shifted to what we now call “clinical decision support”. In the
early 1990s, a group of clinicians and epidemiologists at McMaster University in
Ontario officially coined the term “evidence-based medicine.” Here again, there are
significant potential benefits from well structured clinical data or from systems that
can have deep interactions with providers based on free text. Such a computer sys-
tem can suggest the appropriate medical evidence and the recommended best treat-
ment in any clinical situation. The core idea is that treatments that are shown to
work should be prescribed while those that have not been proven of benefit should
be avoided. With the national focus on healthcare costs this concept, once strictly
the domain of medical science, has become a topic for public, and sometimes even
political, discussion and debate. [
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]
In
Crossing the Quality Chasm
the IOM makes wider use of evidence-based
medicine a top priority. “Scientific knowledge about best care is not applied system-
atically or expeditiously to clinical practice. It now takes an average of 17 years for
new knowledge generated by randomized controlled trails to be incorporated into
practice, and even then application is highly uneven. The committee [that authored
the report] therefore recommends that the Department of Health and Human
Services establish a comprehensive program aimed at making scientific evidence
more useful and more accessible to clinicians and patients.” [
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]
Improved Care Management:
Better management of chronic disease is arguably
the major challenge facing the health system. Among the specifi c issues are the
traditional “one patient at a time and only when they are physically in the office”
