health information technology on patient safety

 

Yasser K. Alotaibi

From the Continuous Quality Improvement and Patient Safety Department (Alotaibi), Medical Services General Directorate, Ministry of Defense, Riyadh, Kingdom of Saudi Arabia and the Department of Patient Safety (Federico), Institute for Health Care Improvement, Cambridge Massachusetts, United States of America

Frank Federico

From the Continuous Quality Improvement and Patient Safety Department (Alotaibi), Medical Services General Directorate, Ministry of Defense, Riyadh, Kingdom of Saudi Arabia and the Department of Patient Safety (Federico), Institute for Health Care Improvement, Cambridge Massachusetts, United States of America 

Abstract

Since the authentic Institute of Medicine (IOM) document become published there was an multiplied development and adoption of health statistics era with various ranges of proof approximately the impact of health information technology on affected person safety. This article is intended to check the contemporary to be had scientific evidence on the effect of different fitness statistics technology on enhancing patient safety effects. We conclude that fitness records generation improves patient’s protection by way of lowering medicine errors, lowering detrimental drug reactions, and enhancing compliance to practice tips. There should be no question that fitness facts generation is an important device for improving healthcare pleasant and safety. Healthcare corporations need to be selective in which generation to spend money on, as literature shows that a few technology have constrained evidence in improving patient safety results. 

Patient safety is a subset of healthcare and is defined because the avoidance, prevention, and amelioration of unfavorable outcomes or accidents stemming from the strategies of health care.1 In 1999 the Institute of Medicine’s (IOM) document “To err is human” known as for growing and checking out new technologies to lessen clinical error,2 and the subsequent 2001 record “crossing the fine chiasm” known as for the use of statistics technology as a key first step in remodeling and converting the healthcare surroundings to attain better and safer care.3

Healthcare statistics generation (HIT) has been described as “the application of data processing involving both laptop hardware and software program that deals with the garage, retrieval, sharing, and use of health care records, records, and know-how for verbal exchange and decision making”.4

Health records era consists of numerous technologies that span from simple charting, to greater advanced decision assist and integration with clinical generation. Health records generation presents severa opportunities for enhancing and transforming healthcare which includes; decreasing human errors, improving scientific effects, facilitating care coordination, enhancing exercise efficiencies, and monitoring information through the years. Since the authentic IOM document changed into posted, there was an increased development and adoption of fitness information era with varying levels of proof about the impact of health records technology on affected person safety.

This review is intended to summarize the modern available clinical evidence on the impact of various health facts technologies on enhancing affected person protection consequences. This overview might be beneficial for clinicians and healthcare policy makers when making evidence based totally choices on procurement and implementation of such era to enhance patient safety. This overview taken into consideration studies that were carried out within the healthcare settings each inpatient and community setting, with an intervention of any of the following; electronic doctor’s orders (CPOE), medical selection guide (CDS), E-prescribing, electronic sign-out and hand-off equipment, bar code medicinal drug administration (BCMA), clever pumps, automated medicinal drug allotting shelves (ADC), digital remedy management record (eMAR), patient records control structures (PDMS), retained surgical gadgets detectors, affected person electronic portals, telemedicine, electronic incident reporting, and electronic medical report (EMR). Our primary results of hobby have been patient protection, scientific mistakes, adverse occasions, medicinal drug errors, unfavorable drug activities, and mortality. The precedence became given to systematic critiques, meta-evaluation and randomized medical trials. If such studies had been not identified then other types of experimental research or epidemiological take a look at designs along with; non-randomized controlled trials, quasi-experimental, earlier than and after research, prospective and retrospective cohort research and case manage studies.

Studies had been excluded in the event that they met any of the subsequent criteria: high danger of bias, studies that were performed in non-scientific settings, cointerventions with non-health information generation interventions, not evaluating affected person protection results, qualitative or narrative studies.

The search method changed into conducted to find each posted and unpublished studies. The search strategy covered Medline, Embase, Cochrane Database. Studies posted till January 2017 had been taken into consideration for inclusion in this evaluation. Initial key phrases used were: Electronic Medical Record (EMR), Electronic Physician’s Order access (CPOE), Clinical Decision Support (CDS), E-prescribing, Electronic Sign-out and Hand-off, Bar Code Medication Administration (BCMA), Closed Loop Medication Administration, Patient Data Management Systems (PDMS), Retained Surgical Items Detectors, Patient Electronic Portals, Telemedicine, Electronic Incident Reporting, Intelligent Infusion Devices, Smart Pump, Programmable Pump, Automated Medication Dispensing, remedy blunders negative occasions, damaging drug activities, negative drug reactions, affected person safety, clinical mistakes. Studies were assessed for methodological validity and danger of bias the use of the Cochrane technique prior to inclusion within the overview.

Computerized physician order access involves the use of electronic or laptop support to enter health practitioner orders together with medicinal drug orders the use of a laptop or mobile tool platform.5 Computerized medical doctor order entry structures have been originally advanced to enhance the safety of medication orders, however greater cutting-edge systems allow electronic ordering of tests, procedures, and consultations as well. Computerized doctor order entry systems are commonly incorporated with a medical selection assist gadget (CDS), which acts as an error prevention device thru guiding the prescriber at the favored drug doses, direction, and frequency of administration. In addition, a few CPOE structures may additionally have the function of prompting the prescriber to any affected person hypersensitive reactions, drug-drug or drug-lab interactions or with state-of-the-art systems it might activate the prescriber in the direction of interventions that ought to be prescribed based totally on scientific tenet recommendation (instance venous thromboembolism prophylaxis). A metaanalysis6 comparing the effectiveness of CPOE to reduce remedy errors and negative drug activities in hospitals located that the implementation of a COPE with clinical decision assist led to large reduction in remedy mistakes (RR:zero.Forty six; 95% CI zero.31 to zero.Seventy one) and destructive drug reactions (RR: 0.47; ninety five% CI 0.35 to 0.60). Similarly, research conducted in community primarily based outpatient services confirmed similar results in lowering remedy errors.7,8 The use of difficult-stops as a degree of forcing function and error prevention in CPOE systems has been studied and changed into found to be powerful in converting prescribing mistakes. However, the usage of difficult-stops ended in clinically important remedy delays.Nine

The use of a stand-on my own CPOE with out CDS does now not appear to lessen medicine mistakes. Studies that have evaluated using a simple CPOE system with out a scientific decision assist machine showed that it did now not enhance ordinary affected person protection or reduce medicinal drug errors.10 Published studies demonstrates that COPE systems are one of the most fastidiously evaluated health records technologies, with a excessive degree of scientific evidence concerning the discount of medication mistakes, however this advantage is only constant while used in mixture with a CDS device.

Clinical decision aid

Clinical choice help gives the health care expert with facts and affected person-precise data. This data is meant to enhance the decision of the healthcare company and is rationally clean and presented to the healthcare specialized at appropriate instances. Clinical selection assist consists of a range of gear to beautify choice-making and the scientific workflow. These gear include notifications, indicators and reminders to care carriers and sufferers, clinical tips, circumstance-particular order sets, patient particular medical summaries, documentation templates, research and diagnostic guide, amongst other equipment.Eleven A Cochrane systematic review12 concluded that using on screen reminders for physicians led to minor to modest enhancements in method adherence, medicine ordering, vaccination, laboratory ordering and clinical consequences.