Healthcare Information Systems: Medical Errors and Patient Safety

Introduction

Healthcare organizations are challenged every day by the need to manage and integrate their clinical, financial, and operational information. In order to meet this challenge, an organization can use a Healthcare Information System (HIS) to help them. Healthcare Information Systems deal with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in healthcare. Health information tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems. These tools are used in the areas of nursing, clinical care, dentistry, pharmacy, public health, and medical research (Hebda and Czar, 2008).

The goal of using Healthcare Information Systems is to help improve patient safety and care while reducing overall healthcare costs. While these outcomes are usually realized, there have been instances of errors occurring. Determining the causes of these errors and implementing plans to prevent them in the future is essential to ensure that everyone involved receives accurate and safe healthcare. This paper explores the factors that contribute to medical errors while using Healthcare Information Systems, which lead to unintended consequences. It also offers an overview of the areas that need improvement related to patient safety, with recommendations for future strategies.

Healthcare Information Systems: Types, Uses, and Components

In order to improve the quality of patient care and keep pace with the increased healthcare needs of the population, Healthcare Information Systems have been put into place. The strategy used is often very comprehensive and addresses all aspects of the care delivery process. HIS are often founded on enterprise information systems that aim to support end-to-end business processes in the healthcare domain. Two major requirements are usually the focus: (1) to provide efficient healthcare-related data management in support of decision-making processes, and (2) to support a continuous process of healthcare resource spending optimization (Gvozdanović, Konáar, Kojundžić, and Jezidžić, 2007).

E-health is based on various information and communication technologies being used in several different ways. Some technologies, such as email, are already in use in most hospitals. Others, such as videoconferencing or the internet, are used more modestly, although their use is growing. Still others represent areas of untapped opportunity. In all cases, it is important that technologies enable the delivery of health services to all primary, secondary, and tertiary healthcare providers (Brommeyer, 2005).

Advances in wireless technology have allowed for the rapid development of mobile applications. The mobile revolution has brought about dramatic and fundamental changes to daily life, influencing the way people live, work, and manage their health. In the healthcare industry, mobile health applications have created a new frontier for offering better care and services to patients, as well as a more flexible way of communicating with suppliers and patients. Mobile applications provide important real-time data for patients, physicians, insurers, and suppliers. They have also revolutionized the way information is managed in the healthcare industry and redefined how doctors and patients communicate (Keng and Shen, 2006).

Over the last several years, wireless devices such as handheld PCs, PDAs, messaging devices, electronic organizers, and smartphones have become increasingly popular. Mobile device ownership has largely been boosted by the evolution of mobile telecommunication networks and the mobile internet, which have expanded into immediate and personalized mobile environments. Wireless communication has been used to equip a mobile healthcare workforce and ensure that ambulatory patients in need of monitoring remain in contact with the necessary systems and services. Healthcare providers regularly carry handheld computers to the bedside, whether in the hospital or at home (Brommeyer, 2005).

Advantages and Disadvantages of Health Information Technology

Information technology has made great strides in many areas around the world. It has not only brought the world closer together but has allowed the world's economy to function as a single, mutually supporting system. This allows information to be shared quickly and efficiently. Because of information technology, communication has also become cheaper, quicker, and far more efficient. It is now possible to communicate with anyone around the globe by simply sending a text message or email, often receiving an almost instantaneous response. The internet has also enabled face-to-face communication across different parts of the world through videoconferencing (Some advantages and disadvantages of information technology, 2008). In the area of healthcare, this has allowed physicians from all over the world to consult on cases more easily and quickly.

Information technology has helped healthcare organizations computerize their business processes in order to streamline them and make them more cost-effective and efficient. This has increased productivity and improved working conditions. IT has also helped bridge cultural gaps by enabling people from different cultures to communicate with one another, exchange views and ideas, and increase awareness. Furthermore, new employment opportunities have been created, including positions for computer programmers, systems analysts, hardware and software developers, and web designers (Some advantages and disadvantages of information technology, 2008).

The biggest advantage that information technology has brought to the healthcare arena is improved patient safety. Because it allows easy access to information, this technology is fundamental to creating more patient-centered health services. E-health has been defined as the use of electronic information and communications technologies to provide and support healthcare wherever the participants are located (Brommeyer, 2005). Additional advantages of healthcare information technology include sensitivity, uniformity and efficiency, timeliness of data availability, and ease of integration into automated systems (Lazarus, Kleinman, Dashevsky, DeMaria, and Platt, 2001). All of this works to increase the quality of patient care while decreasing the overall costs of healthcare.

While information technology has streamlined many business processes, it has also created job redundancies, downsizing, and outsourcing. Although it has made communication more convenient, it has also introduced privacy concerns. From cell phone signal interceptions to email hacking, people are increasingly worried about private information becoming public knowledge (Some advantages and disadvantages of information technology, 2008). In the healthcare arena, the concern is with information flow and the privacy issues surrounding HIPAA.

Industry experts believe that the internet has made job security a significant concern, as technology is ever-changing. This means that healthcare workers must be in a constant learning mode, undergoing ongoing training to ensure they can use new technology as intended (Some advantages and disadvantages of information technology, 2008). The integration of information technology into healthcare has sometimes been slow due to technical issues, process problems, and costs. Primary drawbacks have included re-entry of data by site staff, delays in data accessibility, and the continued need for source data verification (Donovan, 2007). Other obstacles in the development of mobile healthcare applications have included mobile device limitations, wireless networking problems, infrastructure constraints, security concerns, and user distrust (Keng and Shen, 2006). A third problem has been a lack of education on both the importance of information technology and training on how to use specific equipment properly.

Medical Errors Related to Healthcare Information Systems

According to the Institute of Medicine (IOM), medical errors are the fifth to eighth leading cause of death in the United States, with the number thought to exceed deaths related to motor vehicle accidents each year. It is estimated that approximately 7,000 people die from medication errors annually, and most medical errors are system-related. Patient-related errors can occur in any healthcare setting, including physician offices, nursing homes, and inpatient or outpatient environments. An evidence-based assessment report by the Agency for Healthcare Research and Quality (AHRQ) has reported that medical errors are not confined to medication errors—they can also occur from misdiagnosis, misinterpretation of laboratory results with incorrect therapy, equipment failure, infections, blood transfusion errors, or misinterpretation of medical orders (Koshy, 2005). The largest single category, however, remains medication errors.

Drug administration is a major part of the clinical nurse's daily role. Medicines are prescribed by the doctor and dispensed by the pharmacist, but responsibility for correct administration usually rests with the nurse. Each nurse is ultimately accountable for their practice, including preparing, checking, and administering medications; updating knowledge of medications; monitoring the effectiveness of treatment; reporting adverse reactions; and teaching patients about their medications. Unfortunately, medication errors are a persistent problem associated with healthcare practice (O'Shea, 1999).

Medication errors due to illegible handwritten prescriptions, overlooked allergies and drug interactions, and incorrect dosages are frequently problematic. Because of this, technology-based interventions are being used to help reduce their likelihood. Computerized physician order entry (CPOE) has been recognized as one of three initial methods widely adopted by hospitals to help reduce prescribing and transcription errors. Several factors influence the appropriate use of these technologies, including the complexity of the hospital environment, limitations in the number of care components that can be automated, and how the technologies interact with humans. If a technology is not used as intended, increased inefficiency and medical errors can still result (Oren, Shaffer, and Guglielmo, 2003).

Medication errors that occur when using Health Information Systems can result from errors in the systems themselves or from the individuals using them. Errors can occur at any phase of the medication-use process—prescribing, transcribing or documenting, dispensing, administering, and monitoring. Computer-entry errors occur when incorrect data, such as patient names, drugs, drug doses, or laboratory test results, are entered into a computer system. Incomplete data entry also presents a risk for medication errors (Santell, Kowiatek, Weber, Hicks, and Sirio, 2009).

Medical errors cause up to 98,000 people to die every year in the United States and are thought to be the fifth leading cause of death, costing the country an estimated $29 billion annually (Al-Assaf, Bumpus, Carter, and Dixon, 2003). Because of this, there has been a significant push for innovative health information technologies that would provide system-wide support to help reduce medical errors and improve patient quality of care. Studies suggest that effective implementation of health IT—such as electronic health records (EHRs), CPOE, and data exchange networks—has the potential to generate cost savings and improve patient safety. It has been estimated that a widespread, nationwide adoption of EHR systems could produce efficiency and safety savings of $142 billion in the ambulatory care setting and $371 billion in the inpatient setting over the next 15 years (Damberg, Ridgely, Shaw, Meili, Sorbero, Bradley, and Farley, 2009).

Conclusion

Information technology has the potential to improve the quality, safety, and efficiency of health care everywhere. Dispersal of IT in health care is generally low, but surveys indicate that providers are looking to increase their investments. Drivers of investment in IT include the promise of quality and efficiency gains. Barriers include the cost and complexity of IT implementation, which often necessitates significant work process and cultural changes within an organization (Information technology in health care, n.d.). The implications of the changes that must be made in the healthcare sector are clear: we must be prepared to harness and integrate new technologies in order to deliver high-quality, reliable, and timely services to patients everywhere (Brommeyer, 2005).

With all of the new technology that has emerged over the last few years, it is worth considering what potential lies ahead. It would be valuable to know how information technology will change in the medication dispensing area to allow for fewer errors. It would also be interesting to see whether patients will eventually have more control over the medications dispensed to them on a daily basis. This might take the form of more automated hospital dispensing systems that check for allergies and drug interactions, or automated pharmacies that dispense prescribed medications around the clock, making it more convenient for working people who find it difficult to reach a pharmacy during normal business hours.

Medication errors are a real problem and lead to several deaths in this country every year. A foolproof medication dispensing system that would eliminate these errors would benefit everyone. It would give patients a more secure feeling while eliminating a major source of worry for doctors and nurses in their daily duties. Studies that include both healthcare workers and patients in identifying the true causes of medication dispensing errors and determining what can be done to eliminate them are greatly needed. With all of the technology available today, it seems possible to develop a system that could be used by all stakeholders—doctors, nurses, pharmacists, and patients alike—to eliminate the tragedy of medication errors.

In today's healthcare world, there is increasing emphasis on consumer-centric healthcare and making patients more responsible for their own health. The area of medication errors is one in which patients need to become more actively involved in order to increase the safety of medication dispensing. Patients expect to receive the correct medications every time they need them, and anything less is not acceptable in the modern healthcare environment.

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