The financial burden of patient harm at the hands of hospitals is likely more than $100 billion annually, but if those same hospitals had access to reliable, real-time data it would go a long way in curbing both harm and costs, according to a new survey.
Pascal Metrics, a Washington, D.C.-based patient safety organization, recently unveiled a white paper detailing the latest obstacles and efforts surrounding patient harm, which could be anything from patient death on the extreme end to an allergic reaction to medications.
Despite the industry-wide shift toward electronic medical records and the promise of making the health system more connected, scores of health systems across the U.S lack the technological know-how to best address patient harm, though many would like to, according to Dr. David Classen, chief medical information officer for Pascal Metrics.
“For all the money we spent on technology, patient safety is still a huge problem in hospitals as well as ambulatory care in general,” he said, citing a 2011 study by the Institute of Medicine that spurred Pascal to take on the issue. “After all this investment, we still have all this patient harm that is occurring.”
To that end, more than $30 billion has been directed toward electronic health record adoption since 2009, but it’s been a patchwork of systems with varying degrees of success, Dr. Classen said.
Ninety percent of responding hospitals and health systems noted that patient harm is commonly discussed in their healthcare system, yet only 24 percent said they felt their current technologies show detailed harm rates and patterns in their units. That raises the question: Is there enough data to turn conversations into actionable practices that cut down on patient harm?
“Most hospital discussions about patient safety are informed by retrospective data that is reported voluntarily and only detects less than 10 percent of all harm,” said Dr. Classen. “Reducing patient harm must start with clinically reliable data that’s available in real or near-real time, so you can do something about it.”
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
So how might a hospital or health system begin to effect change?
Incorporating a model similar to that of the aviation industry, a live patient monitoring air traffic control tower, of sorts, is where the industry needs to focus, Dr. Classen said.
“We use aviation as an example of an industry that is ultra high-risk, but ultra safe,” he said. “It’s what we should emulate.”
Certain procedures, say open-heart surgery, are perhaps just as high stakes as piloting a commercial airliner, but the healthcare industry has never had the real-time data element that can guide and assist, not replace or dictate terms, to the physicians and healthcare teams, Dr. Classen said.
“We’re not replacing care, but we’re merely providing support for them,” he said. “(Physicians) make the ultimate decisions. We don’t say ‘here’s the data, now do this.’ We say ‘here’s the data, think about it and see what works best.’ We’re finding that’s the only way it works.”
It seems like a sensible approach, and providers are overwhelmingly on board with the idea – 98 percent of survey respondents said it would be valuable to have the technology that showed patient harm risks and patterns data in real time. So why hasn’t the industry adopted it sooner?
For starters, hospitals and health systems are reasonably fearful of disclosing too much information, save for blatant mistakes, lest they face additional lawsuits from circling plaintiff’s attorneys, said Dr. Will Andrews, vice president of client development for Pascal. As such, the traditional method of voluntary reporting has been rather limited.
“What we’ve always relied on is voluntary event reporting, asking if something goes wrong,” Dr. Andrews said. ” But that only captures a very small percentage of all the harm that goes on.” Dr. Classen added that only about 10 percent of actual harm is reported, meaning that data that does exists is neither revealing nor telling enough to make a substantial difference in reducing patient harm.
Dr. Andrews said that underscores the importance of PSOs, where health systems can share more on their own performance without fear of litigation.
“People need to feel safe to uncover something,” he said.
Patient harm, Dr. Classen said, is costly for the entire system, but increasingly, as more patients are steered toward high-deductible health plans, it’s the patients themselves who end up taking a bigger financial hit, particularly when the harm leads to more laboratory work or X-rays.
While some level of patient harm — particularly more minor but nevertheless pricey harm — is inherent, the industry as a whole is learning that’s quickly changing, too.
“We used to say, if you got an infection from a catheter, we would say probably one-third were preventable,” Dr. Classen said. “Now we have studies that show they’re all preventable. We’re clearly changing our view of what is preventable and what is not. Maybe these events which we thought were just the cost of doing business maybe don’t need to be.”
