How could ‘patient friendly orders’ cut the error rate in hospitals?

6:00 am by | 3 Comments

In previous posts, I've talked about the perfect storm for innovation - alignment of an idea, policy, technology, people, and incentives.   Roni Zeiger, a world class informatician who provided physician leadership for the Google Health project in the past,  recently suggested an idea which I think has the potential for significant innovation in the world of patient and family engagement - Patient Friendly Orders.

Here's an analogy. Last night I went to a neighborhood grocery store, Roche Brothers, to purchase a few vegetables.    They were having a sale on romaine lettuce and a special bar code on each lettuce reminded the checker to give a dollar off per head.

Next to the cash register, a "consumer friendly display" showed each item scanned in plain english, not some odd abbreviation like Rmne Lttc, and its price.   At the end of checkout, I noticed she forgot to scan the dollar off discounts, so I pointed to the display, identifying the problem.   She immediately corrected it.

Imagine if every patient had access to a web page of their current hospital orders in patient friendly terminology i.e.

You are receiving an antibiotic called Ceftriaxone to treat your lung infection.  It is being given once per day in your IV.

You are receiving Tylenol for your fever.   It will given every 4-6 hours as needed for fever.   You may requested it for pain but note that no more than 8 tablets will be given per day because more could adversely affect your liver.

You may request Benadryl as a sleep aid in the evening

I've posted the story of my mother's recent hospitalization for a broken hip and the challenge I experienced trying to obtain a list of the medications she was given (a total of 22, instead of the 2 she was actually supposed to take).     Such a problem would not have occurred with Patient Friendly Orders.   I could have scanned her orders from the airport before the flight to visit her and could have called the hospitalist with corrections.   My mother would have immediately recognized the inappropriate nature of the treatment she was receiving since the vast majority of medications were discontinued years ago.

There are informatics, educational, and policy challenges to implementing Patient Friendly Orders, but I do not see it as much more complex than the Open Notes project we recently completed.

Maybe the National Library of Medicine, with it's wonderful vocabulary/code set resources and patient friendly educational materials could lend a hand.

Definitely worth a pilot and maybe even a new product development opportunity for a start up!

Thanks, Roni, for a great suggestion.

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Dr. John D. Halamka

By Dr. John D. Halamka

Dr. John D. Halamka is chief information officer and dean for technology at Harvard Medical School who writes at Life as a Healthcare CIO.
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3 comments
Peggy Zuckerman
Peggy Zuckerman

This is a perfect example of patient-friendly or accessible information, and the very existence of this type of information delivered directly and quickly to the patient will promote more patient engagement in his/her treatment.  Just having that information available becomes a prompt to continue the dialog with the provider,

"How do we know if the antibiotic is working?" or "Will I have to take this med when I get home?".  Make it easy, and make it an avenue for further partnership with the provider.

txv8913
txv8913

The idea is great! This could change the way patients view healthcare for the better. Only pulll factor I see is cost, at least to start with. Economically, I see no motivation for managers to invest in such investment. But, if an initiative like this reduces medication errors, then I see no reason why we should not have stuff like this in hospitals - Kumar, Medical Informaticist.

Cashwell
Cashwell

This idea fits wonderfully with the concept of individual patient computing at bedside.  Companies like Lincor Solutions and Getwellnetworks are replacing the "TV" with an interactive clinical and patient monitor at bedside, which could  display all orders, medications, requirements that the patient could verify and review at anytime.  This power of personal interaction at bedside improves the patient experience from an entertainment and education perspective as well as a clinical use as Drs and Nurses enter the room with access to the patient's medical records immediately.