Charles John Palenik, MS, PhD
Medical care is becoming increasingly complex. Most research efforts focus on improved diagnosis and treatment. Less emphasis is directed toward how care is actually provided. Poorly functioning operational systems have lead to well-documented problems concerning medical safety. There are numerous examples of adverse drug events due to human error, proximal causes, and systems failure.
The risk of harm associated with medical care has received increased scrutiny over the last 15 years. Improvements in information technology (IT) could lead to safer health care. Safe medical treatment today requires a level of sophistication almost impossible without computer support. Technology has been shown to improve practitioner performance and sometimes clinical outcomes.
A fine review of this topic appeared recently (Bates DW and Gawande AA. "Improving safety with information technology." N Eng J Med 2003; 348:2526-2534). The authors feel that information technology can improve safety by preventing errors and adverse events through 1) facilitating a more rapid response after an error has occurred and 2) tracking and providing feedback concerning adverse events.
Tools useful in the prevention of errors and adverse events include improving communication, providing better access to information, requiring information analysis, assisting with calculations, and decision support. Cross-coverage of patients by more than one health-care provider is known to increase treatment errors. Hand-held technology now allows simultaneous electronic access to medical records, approval of treatment plans, and notification of laboratory results with abnormality warnings. Access to reference information can improve safety. Desktop, laptop, and now hand-held computers allow easy access to textbooks, references on drugs, treatment schemes, and the Medline database. A review and evaluation of Internet-based clinical-reference tools is available at www.uptodate .com/whitepaper/UTD_WP_Internet_Tools.pdf.
Another error-reduction strategy performed by computers is called "forcing function" — software tools that restrict the manner in which tasks are performed. For example, legible prescriptions can be written electronically. The computer then checks on the availability of a specific dose and for drug-drug interactions. Bar-coding of patient information and records helps by preventing incorrect procedures from being performed. By entering a treatment into the computer, corollary orders can be suggested. Outcomes of one treatment may cause concerns in other areas to emerge. This idea attempts to minimize errors of omission by identifying common outcomes of a single intervention. Computers also can help reduce errors of calculation.
Often, monitoring is considered routine to the point of being boring. IT monitors not only record data, but can perform analytic functions, and, if given threshold values, can issue trends and even warnings. IT also can help in decision-making processes. Review of medical records by computerized algorithms and neural networks allow multiple factors to be considered simultaneously. Probable clinical outcomes could then be identified.
IT tools also can review medical records to identify, intervene early-on, and track the frequency of adverse events. Computerization can help measure outcomes of diagnosis and treatment. Electronic tools are currently being developed to better identify adverse events in a variety of clinical settings.
Despite the substantial improvements in patient safety that can be realized through IT, numerous barriers retard complete implementation. Most IT in use today involves billing processes rather than clinical care. Financial incentives for change need to be identified. Also, there is no single standard for the codification of most important types of clinical data. Many clinicians have not yet accepted the importance of IT as part of medical research or practice. As a result, only a limited number of IT forms that may improve safety have been widely implemented. However, IT has the definite potential to structure care, catch errors, and provide evidence-based, patient-centered decision support.
The Organization for Safety and Asepsis Procedures (OSAP) is the leading source for infection control and safety information in dentistry. OSAP uses IT to share information on its homepage, www.osap.org.
Dr. Charles John Palenik is an assistant director of Infection Control Research and Services at the Indiana University School of Dentistry. Dr. Palenik has authored numerous articles, book chapters, and monographs, and is the co-author of the popular Infection Control and Management of Hazardous Materials for the Dental Team. He serves on the Executive Board of OSAP, dentistry's resource for infection control and safety.Questions about this article or any infection-control issue may be directed to [email protected].
