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Medical Errors, Patient Death and Harm

May 12, 2016

Recently researchers at Johns Hopkins published a paper stating that medical errors are the number three cause of death in the United States. While this is quite astounding, many are not surprised. Since the mid-1990's there has been recognition that medical errors are a major cause of death in the US. Just about everyone I know in the healthcare industry has read or is at least aware of the “To Err is Human” report published in November 1999 by the National Institute of Health which more or less states the same thing as the Hopkins paper – and that was released 17 years ago.

 

 

 Ultimately the 1999 NIH report launched US hospitals into the implementation of Electronic Medical Record systems in an effort to reduce errors. Among other things, alerts and managing the “5 rights” of medication administration electronically were to be the savior of medical errors.  Based on the Hopkins paper, we all now know that the desired outcome simply has not been obtained. If it had, the Hopkins paper would have had a different finding.

 

However, one can only imagine the number of deaths that would have been caused by medical errors if such systems had not been implemented. No doubt, despite the finding of the Hopkins paper, implementation of EMRs have had a dramatically positive impact on the reduction of medical errors.

 

What is concerning in all of this though, is that little is said about medical errors that cause harm. It’s likely that this is because data regarding “harm” is difficult, if not impossible to obtain. How is “harm” quantified today? Adverse drug event reporting by nursing staff? Other reporting by clinical staff?

It is very likely that there is a great deal of patient “harm” that is incurred but never reported. Not because nursing or other staff are not reporting the events, but because the patient is not a part of the reporting process.

 

Patients suffer side effects, adverse reactions and other harm during their treatment that is never reported because Patient Reported Outcomes are not frequently collected.

However, patient reported outcomes can be a wealth of about harm, minor or major. The need to collect patient reported outcomes is not limited to clinical care, but also should be a major source of data for analytics during research, clinical trials, studies and post market surveillance for medical devices and medications.

 

The shift to “Value Based Reimbursement” (VBR) by CMS highlights even further the need to collect relevant Patient Reported Outcomes. How can CMS effectively measure outcomes if the entire patient outcome is not considered?  A “good” clinical outcome may not necessarily mean a “good” outcome for the patient for example. Quality of life indicators need to be included in the reporting requirements for any of the VBR programs.

 

 

 

In order to fully involve the patient, more fully determine outcomes, including inadvertent “harm,” the healthcare system needs to see the patient as an integral part of the treatment planning, decision making, treatment execution and follow-up process.  Not only does the patient need to be a part of the process but they also need to feel as such.  Data about quality of life, not just clinical outcomes are necessary - Patient Reported Outcomes, personalized patient education, dramatically improved communication and collaboration with the patient is a start towards not only reducing errors, but reducing harm caused to patients.

 

We developed the Personalized Patient Experience Platform with a view to addressing issues raised above, allowing among other things, a better understanding of the patient situation before, during and after treatment.

 

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