This adjustment is coming, but slowly. The most important progress is the acceptance that a team, not an individual, provides health care. Finger-pointing at individuals encourages professionals to hide errors; finger-pointing at systems of workflow can encourage change.
A study in an intensive-care unit found 1.7 errors per day per patient, with a third being life-threatening. The greatest source of error was communication problems. In other words, troubles moving information from one skilled, dedicated professional to another was the biggest safety issue.
Technology, properly implemented, can knit systems of individuals together, and "make sure the right thing to do is actually the easier thing to do," Sophia Chang, an executive at the California Healthcare Foundation, told attendees at a recent conference in San Francisco for using IT to manage chronic conditions.
In a recent article in Health Affairs (which also provided much of the background for this column), Robert Wachter, chief of medical service at the University of California, San Francisco, graded overall IT a B-minus for its impact on safety.
The main problems are that there are few "off-the-shelf products, and that the institutions that have seen the most progress are the ones that already have years of experience and dedication to clinical information systems.
Another danger, Wachter said, is that health care institutions that invest heavily in health IT may feel theyve already used up their budget for efforts to improve safety.
Getting safer systems can mean spending considerable sums, and for the most part, hospitals and physicians are paid the same amounts regardless of whether they are pioneers or slackers in providing safety. We need to adopt the attitude that safety is worth tracking and paying for. Again, solutions are emerging, and technology is the underpinning.
Accreditation programs require hospitals to report rates of providing specific preventive care as well as other indicators of quality. This information is being made publicly available on the Internet and eventually will help patients exert purchasing pressure.
Health care payers are starting to reward safety with cash, despite logistical difficulties. Its much simpler to pay and bill for medical procedures than for safety practices. Procedures can be counted; the benefits of safer practices are not so straightforward to assess. Nonetheless, hospitals and insurance plans are instituting pay-for-performance policies, which tie safety practices to specific procedures.
Anthem Blue Cross Blue Shield, for example, is paying more than $4 million to hospitals if doctors enter medication orders electronically, or if health care professionals document doing simple preventive procedures, such as giving aspirin to patients suffering from heart attacks. The program applies to well over half of hospital patients covered by Anthem.
An informal survey done by Wachter found that 45 percent of 400 health care workers felt that safety had improved over the past five years, and 67 percent felt that it would improve more over the next five years. But only 7 percent said clinical IT had made the most difference, well behind regulations from JCAHO (Joint Commission on the Accreditation of Healthcare Organizations).
Still, even a low percentage improvement could be good news for information technology. As health IT becomes integrated into the standard of care, it can become an essential, but unnoticed function, like breathing. That could mean that health care is not only being envisioned as a system, but actually working as one.