Will Adoption of EMRs Cause Hospital Error Rates to Soar?

Voluntary human reporting of errors will be replaced by 'Global Trigger' tools

Its nearly impossible to receive meaningful information from hospitals or physicians about the quality of their work. The information that is available is from data that is tabulated from voluntary contribution of mistakes. I am not sure we need advanced degrees in psychology to understand that it is entirely against human nature to call out our own mistakes, and the mistakes of others...especially when a multi-million dollar lawsuit or loss of ones livelihood may be the result.

So, it may not come as a surprise, that despite more than a decade of national focus on patient safety, medical errors and other adverse events occur in one-third of hospital admissions—as much as ten times more than some previous estimates have indicated, according to authors of a new study in the April issue of Health Affairs .

The patient safety study, conducted by David Classen of the University of Utah and coauthors at the Institute for Healthcare Improvement, compared three methods for detecting adverse events in hospitalized patients, including the Institute’s own Global Trigger Tool. The study drew on comparable samples of patients from three leading hospitals that had undertaken quality and safety improvement efforts.

Among the 795 patient records reviewed, voluntary reporting detected four events, the Agency for Healthcare Research and Quality (AHRQ) Indicators detected 35, and the Global Trigger Tool detected 354 events, ten times more than the AHRQ method. In other words, the AHRQ indicators and voluntary reporting missed more than 90 percent of adverse events identified by the Global Trigger Tool. If anything, the researchers say, their findings are conservative, because they rely on medical record review, which would not detect as many adverse events as direct, real-time observation would.

The researchers say that reliance on voluntary hospital reporting or the AHRQ indicators could lead to seriously flawed perceptions of patient safety in the United States. They also note that the Global Trigger Tool detected a much higher rate of adverse events for hospitalized patients than previous studies have shown. Although the Global Trigger Tool is a somewhat more resource-intensive method because it involves medical record review, the researchers suggest that it could be incorporated into commercial electronic health record systems, thus making it easier and less costly to use.

I believe that we will see the rate of adverse events begin to increase as we approach the end of the $44,000 per physician EMR federal stimulus payments, and the graduated introduction of Medicare EMR milestones thru 2015.

As the reported US medical error rate begins to approach the reality of medical practice, it will be interesting to see how risk managers view the comparison of local care versus a global healthcare option, when the true medical outcomes are compared.

Could the statistics eventually show that it is a greater medical risk for an employer to send patients to the local hospital with questionable outcomes, vs the super specialty hospital in Bangalore that delivers extraordinary medical outcomes and patient satisfaction?