Journal of the American Medical Informatics Association 8:299-308 (2001)
© 2001 American Medical Informatics Association
Affiliations
of the authors: Harvard Medical School, Boston, Massachusetts (DWB);
Institute for Safe Medication Practices, Huntingdon Valley, Pennsylvania (MC);
Harvard School of Public Health, Boston (LLL);
Indiana University of Medicine, Indianapolis, Indiana (JMO);
University of California–Los Angeles School of Medicine, Los Angeles,
California (MMS);
Massachusetts Institute of Technology, Cambridge, Massachusetts (TS).
Correspondence
and reprints: David W. Bates, MD, MSc, Division of General Medicine and Primary
Care, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115;
e-mail: ision of General Medicine and Primary Care, Brigham and Women's
Hospital, 75 Francis Street, Boston, MA 02115; e-mail: ision of General
Medicine and Primary Care, Brigham and Women's Hospital, 75 Francis Street,
Boston, MA 02115; e-mail: <dbates@partners.org>.
Background: Increasing data suggest that error
in medicine is frequent and results in substantial harm. The recent
Institute of Medicine report (LT Kohn, JM Corrigan, MS Donaldson,
eds: To Err Is Human: Building a Safer Health System. Washington,
DC: National Academy Press, 1999) described the magnitude of the
problem, and the public interest in this issue, which was already
large, has grown.
Goal: The goal of this white paper is to
describe how the frequency and consequences of errors in medical
care can be reduced (although in some instances they are
potentiated) by the use of information technology in the provision
of care, and to make general and specific recommendations regarding
error reduction through the use of information technology.
Results: General recommendations are to
implement clinical decision support judiciously; to consider
consequent actions when designing systems; to test existing systems
to ensure they actually catch errors that injure patients; to
promote adoption of standards for data and systems; to develop
systems that communicate with each other; to use systems in new
ways; to measure and prevent adverse consequences; to make existing
quality structures meaningful; and to improve regulation and remove
disincentives for vendors to provide clinical decision support. Specific
recommendations are to implement provider order entry systems,
especially computerized prescribing; to implement bar-coding for
medications, blood, devices, and patients; and to utilize modern
electronic systems to communicate key pieces of asynchronous data
such as markedly abnormal laboratory values.
Conclusions: Appropriate increases in the use of
information technology in health care— especially the introduction
of clinical decision support and better linkages in and among systems,
resulting in process simplification—could result in substantial
improvement in patient safety.