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Technology and Patient Safety

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Using a national representative and large sample of Medicare patient data, the authors of this article sought to link implementation of health IT to the clinical outcomes, which allowed them to apply a difference-in-differences method to measure adjustments in patient safety with adjustments in health IT investments.  Data spanning four years (1999-2000) was observed for each hospital that was examined.  Three health IT applications were analyzed and these included picture archiving and communications systems (PACS), electronic medical records (EMRs), and nurse charts applications.  The outcome measures of the study included three patient safety indicators and these were: post-operative hematoma or haemorrhage, infection as a result of the medical care, postoperative deep vein thrombosis (DVT) or pulmonary embolism.  The authors selected these indicators after consulting with the health care professionals to get the outcomes that were likely to be influenced by health IT.  Patient characteristics such as sex, race, and age among others were controlled.  Multivariate regression analysis was used to determine the relationship between the patient safety indicators and a group of health IT indicators, patient controls, as well as interactions between time and health IT applications. The authors also included a complete set of hospital, as well as time fixed effects which allowed for estimation of changes in patient safety outcomes following the adoption of health IT.  The study found EMRs to be the only health IT application having a distinct and statistically significant effect on patient safety.  EMRs use was particularly associated with significant reductions in infections due to medical care. However, nurse charts and PACs were found to have no systematic association with any indicator. This study contributes to the inconclusive literature that exists about the issue of technology/informatics in promoting the patient’s safety.

Kilbridge, P.M. & Classen, D.C. (2008). The Informatics opportunities at the intersection of patient safety and clinical informatics. J AM Med Inform Assoc, 15: 397-407.

This position paper addresses obstacles that prevent the use of health informatics in improving patient safety. The authors of the article note that while health informatics has been demonstrated to promote patient safety, various challenges make it quite difficult to improve it. The article aims at offering recommendations on ways of dealing with these challenges. The authors provide recommendations on how health informatics can be effectively used to promote and improve patient safety.  Some of the recommendations include adequate health staff training on the use of available informatics, conduction of more research addressing health informatics and patient safety, and encouragement of hospitals to adopt electronic health records. The authors believe that once the arising challenges of the use of health informatics are addressed, the greater improvement in patient safety will be achieved.

IOM (2011). Health IT and Patient Safety: Building Safer Systems for Better Care. Consensus          

Report, Institute of Medicine.

Realizing the widespread use of IT in medical care, IOM was directed by the Department of Health and Human Services to compile this report which is basically an evaluation of health safety issues arising from the use of health IT and recommendations on how these issues can be addressed at both the governmental and private sector levels. According to the report, an effective use of health IT depends on many factors including patients and healthcare professionals.  The report found that the safety concerns of health IT should not be addressed from a single cause perspective, but from a much wider perspective involving the whole care system, in order to come up with an intervention to improve the safety of the system. According to the report, all stakeholders including patients, health professionals, private sector, and the government have distinct roles to play. In the report, the IOM makes certain recommendations, which include promotion of sharing of safety data, improving measures, standards, and criteria for the safe use, and finally promoting accountability and transparency. It is important to note that these recommendations are not similar to the ones found in Kilbridge and Classen study cited above.

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