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White Paper |
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{at}partners.org>.
Received for publication: 10/09/00; accepted for publication: 03/16/01.
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.
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