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(originally published by Booz & Company)


Patient Safety: A Data-Driven Prescription

With some modifications, AERS could be used as a template for a patient safety reporting system, because medical treatment specialists in the Department of Health and Human Services, the Centers for Disease Control and Prevention (CDC), the Veterans Administration, and the Department of Defense’s Military Health System face many of the same data shortcomings as the FDA did a few years ago. Currently there is no standard, automated mechanism for collecting details about incidents in which patients receive less than ideal treatment because of diagnosis failure, ignorance, or misinformation. Hospitals and physicians operate in a litigious culture in which mistakes are not addressed openly or shared for their learning value. Consequently, most of these errors are never recorded, analyzed, or corrected.

Critical examination of the available body of literature pertaining to medical conditions and collaboration with medical associations that are already establishing treatment protocols in their fields can help a governing organization set guidelines for a standard of care. These guidelines, governing what physicians are compelled to do under specific medical circumstances, can then be coded in a database that is constantly updated with information from health-care providers and hospitals describing their actions – and the results – during patient encounters. (Patients’ names would be withheld to protect confidentiality.)

Corporate America, bearing the brunt of the high cost of medical mistakes, doesn’t need any additional encouragement to support patient safety.”
The databank would automatically modify these standard treatment guidelines when certain protocols proved to be more successful. Errors would be highlighted and analyzed for any underlying trends. All of this data would then be available to health-care providers via computer to use as a means of improving the level of their performance. In a simplified format, it could be provided to patients via the Internet.

A system like this offers several advantages. For one thing, a computerized, searchable source of best medical practices could benefit millions of patients under the care of rural physicians, who face many unfamiliar complaints and conditions and may lack a single, reliable, up-to-date source of the best and most effective treatment courses. And in a health-care landscape that is increasingly patient-focused, this database could be a credible repository of treatment options for people bewildered by the array of good and bad medical information on the Web.

Hurdles and Incentives
Some physicians oppose a patient safety databank, because they fear that such an information network would bring about more malpractice suits amid further monitoring of their practices. But for the best doctors, the opposite could occur: Physicians whose pattern of performance meets or exceeds the clinical benchmarks detailed in the safety databank could avoid malpractice suits because they would have evidence that their level of patient care matches or goes beyond minimum national health-care standards. In addition, these physicians could be rewarded for consistent adherence to patient safety guidelines with lower malpractice premiums.

There are also potential economic incentives for hospitals to eliminate errors. Health-care mistakes often severely undercut a hospital’s reputation, such that additional financial resources are needed to reestablish its public image. Furthermore, in the most dire cases, poor patient safety may lead to high-ticket litigation, poor employee morale, and even loss of the customer base. Accreditation organizations, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), can encourage increased use of clinical standards and enhanced reporting of physician/patient encounters by assigning a designation of excellence to hospitals that meet the highest safety standards. Hospitals can then use this designation to attract more patients.

Business Takes Action
Corporate America, bearing the brunt of the high cost of medical mistakes, doesn’t need any additional encouragement to support patient safety – and some companies are not waiting for legislation or the development of a national database to do something about it. General Motors Corporation is a good example. The automaker is the largest private purchaser of health care in the U.S.; its medical plan covers 1.2 million people, and its yearly contribution to employee health insurance is about $4 billion. To cut down on medical errors, GM has begun to provide physicians with Palm PDAs that have a preinstalled drug database and prescription-writing program. Using this software, physicians can access current information about thousands of drugs and receive alerts about newly discovered drug interactions. GM made the decision to supply the PDAs and software after a Harvard study revealed that prescription drug errors decline by 55 percent when doctors use electronic prescription systems.

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  1. “Health Care’s New Electronic Marketplace,” by J. Philip Lathrop, Gary Ahlquist, and David G. Knott, s+b, 2Q 2000. Click here.
  2. “HMO’s  “R” Us: A Prescription for the Future,” by Philip Lathrop and David C. Carlebach, s+b, 4Q 1998. Click here.
  3. “Vertical Integration: 80’s Fad or Health Care’s Future?,” by David G. Knott, s+b, 3Q 1997. Click here.
  4. “A Trillion-Dollar Opportunity,” by Gary Ahlquist, David G. Knott, and J. Philip Lathrop, s+b, 4Q 2001. Click here.
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