Health information technology (HIT) has the potential to improve patient safety by facilitating evidence-based decision making, minimizing error due to human factors, such as illegible handwriting and imprecise recollection of dosing recommendations, and enhancing the reporting, tracking, and aggregation of patient data.,,
In 2019, articles published on PSNet on the use of HIT to improve patient safety focused on reducing errors in four areas:
- Adverse drug events
- Diagnostic errors
- Transfusion safety
- Adherence with evidence-based care
While there are a variety of HIT practices that may address each one of these areas, this essay focuses specifically on HIT practices highlighted in resources published on PSNet.
Reducing Adverse Drug Events
Adverse drug events (ADEs) are a common patient safety event across all settings of care. Specifically, ADEs account for approximately one third of all inpatient hospital adverse events. HIT solutions such as electronic dosing, mobile applications, EHR medication reconciliation tools, and clinical decision support (CDS) alert systems can improve medication safety by increasing the quality of documentation, supporting accurate prescribing practices, and by facilitating information exchange.
One featured approach is the use of barcoding and scanning protocols in the medication delivery process to reduce the risk of ADEs. Several articles recommended barcoding in perioperative care and the operating room settings as risk reduction strategies to prevent medication administration errors. In addition to these examples, barcode scanning nursing protocols may have the potential to reduce the risk of wrong-patient insulin pen errors.
Another approach highlighted by several articles is the use of computerized provider order entry (CPOE) within CDS to reduce medication errors. The results of a systematic review concluded that the use of CPOE reduces the overall medication error rate as well as specific error rates for wrong dose, wrong drug, administration frequency, administration route, and drug-to-drug interaction errors. However, the implementation of CPOE can introduce new types of errors and may not prevent errors that are not rule-based, such as technical or memory errors. CPOE and continued pharmacist review are both essential for more comprehensive error prevention.
HIT Approaches to Impacting Diagnostic Errors
The true magnitude of diagnostic errors is difficult to quantify. However, the National Academy of Medicine estimates that most people will experience at least one diagnostic error over the course of their life. While diagnostic errors may not always necessarily lead to a harm, they can result in a delayed- or inappropriate- treatment.7 HIT has the potential to help providers improve the diagnostic process and reduce diagnostic error by providing easier access to critical patient data, facilitating information exchange, offering complex analysis, and retrieving workflow and decision making information.7 Specific HIT approaches may include the use of CDS, diagnostic study interpretation, and trigger tools.
In 2019, PSNet included multiple resources that identified artificial intelligence (AI) systems as a rapidly emerging healthcare technology with the potential to improve diagnostics. Specific examples highlight the use of AI in pediatric diseases. AI-based systems could support physicians in the analysis of large amounts of data for diagnostic evaluations and provide clinical decision support when there is diagnostic uncertainty or complexity. Some deep learning AI diagnostic algorithms achieve similar diagnostic accuracy to physicians, although authors note more testing in clinical settings is needed.
Barcoding to Improve Safety in Transfusions
More than 20 million blood components are transfused annually in the U.S.,,,, with approximately 51,000 adverse reactions related to transfusions. Labeling issues are a major source of transfusion errors, causing patients to receive incorrect blood types. Barcoding can alleviate the risk of labeling errors in transfusions by reducing the potential for human error in the validation processes. One 2019 article demonstrated that barcoding, in conjunction with an electronic auditing system, was safer than a manual verification system for transfusions in the operating room.
Clinical Decision Support and Increased Adherence with Evidence-based Care
CDS has the potential to increase provider adherence to best practice, evidence-based care by codifying standards in a way that can be easily accessed by clinicians. This may include, but is not limited to, notifications, alerts and reminders, condition-specific order sets, clinical summaries, and templates.3 One systematic review demonstrated that the use of CDS in oncology care increased clinical practice guideline use and concordance, improved care process measures, and reduced safety events. Further, integration of AI into CDS software has the potential to further improve knowledge management for clinicians and enhance the analytic capabilities and outputs of CDS software. For example, AI systems are being developed that can detect complex, time dependent conditions such as sepsis or warning signs of patient deterioration.
AHRQ’s CDS Connect project is facilitating the use of evidence based standards of care via shareable, standards-based CDS resources. In addition to the artifacts already available through the project, the CDS Authoring Tool enables users to create their own CDS artifacts.
What is on the Horizon?
Dr. Hettinger is an employee of MedStar Health and is a volunteer with the AAMI Health IT Standards Committee, DC Health Information Exchange Advisory Board, and Cerner Strategic Opioid Advisory Board. He has also received grant funding from AHRQ, FDA, ONC, DOD, AMA, and PEW Charitable Trust.
Aaron Zachary Hettinger, MD, MS, FACEP, FAMIA
Medical Director and Director of Cognitive Informatics, National Center for Human Factors in Healthcare
Kendall K. Hall, MD, MS
Managing Director, IMPAQ Health
Eleanor Fitall, MPH
Research Associate, IMPAQ Health
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