The Impact of Health Information Technology on Patient Safety
Abstract
Health information technology (HIT) has become an integral part of the healthcare industry, with the aim of improving patient safety outcomes. This article reviews the current scientific evidence on the impact of different health information technologies on patient safety. The study concludes that HIT plays a significant role in reducing medication errors, adverse drug reactions, and improving compliance to practice guidelines. However, healthcare organizations need to be selective in their investment in technology, as some technologies have limited evidence in improving patient safety outcomes.
Introduction
Patient safety is a crucial aspect of healthcare, focusing on the prevention, avoidance, and amelioration of adverse outcomes or injuries resulting from healthcare processes. In 1999, the Institute of Medicine (IOM) released a report titled "To Err is Human," which highlighted the need for new technologies to reduce medical errors. Since then, there has been an accelerated development and adoption of health information technology (HIT) in healthcare settings.
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The Impact of Health Information Technology on Patient Safety |
The purpose of this article is to review the scientific evidence on the impact of different health information technologies on patient safety outcomes. By understanding the effectiveness of these technologies, healthcare professionals and policymakers can make evidence-based decisions on their procurement and implementation to improve patient safety.
Electronic Physician's Orders and E-Prescribing
Computerized physician order entry (CPOE) systems involve using electronic or computer support to enter physician orders, including medication orders. These systems are usually integrated with clinical decision support (CDS) systems, which provide error prevention tools and guidelines to prescribers.
A meta-analysis evaluating the effectiveness of CPOE with CDS in reducing medication errors and adverse drug events found significant reductions in medication errors and adverse drug reactions. These systems guide prescribers on preferred drug doses, routes, and frequencies, as well as prompt them about patient allergies, drug interactions, and clinical guideline recommendations.
On the other hand, the use of a stand-alone CPOE without CDS does not seem to reduce medication errors significantly. Therefore, the integration of CDS with CPOE is crucial to achieve better patient safety outcomes.
E-prescribing is another HIT technology that improves medication safety by electronically transmitting prescriptions from healthcare providers to pharmacies. It reduces the likelihood of medication errors and improves medication adherence. Studies have shown that e-prescribing improves medication safety in both inpatient and community-based outpatient settings.
Clinical Decision Support
Clinical decision support (CDS) provides healthcare professionals with patient-specific information and guidance to enhance decision-making. This includes notifications, alerts, reminders, clinical guidelines, and more.
Research has shown that on-screen reminders for physicians can improve process adherence, medication ordering, vaccination, laboratory ordering, and clinical outcomes. However, physicians tend to frequently ignore alerts from CDS systems. Modifications to CDS systems, such as tiering and automation of alerts, can improve physician compliance.
CDS systems that provide simple advice are less likely to succeed, while those that require justification for over-riding alerts, provide advice to both patients and practitioners, and are evaluated by their developers have a higher chance of success. Overall, CDS systems have been proven to improve the quality of care and patient safety, although results may vary depending on system designs and implementation methods.
Electronic Sign-out and Hand-off Tools
Effective communication and handover of patient information are essential for ensuring patient care continuity and safety. Electronic sign-out applications are tools used to facilitate structured transfer of patient information during healthcare provider handoffs.
Studies evaluating electronic hand-off tools have shown improvements in the process of handover, fewer omissions of critical patient information, and reduced handover time. However, more research is needed to evaluate the impact of these tools on patient outcomes.
Bar Code Medication Administration
Bar code medication administration (BCMA) systems integrate electronic medication administration records with bar code technology to prevent medication errors. These systems ensure that the right patient receives the right medication at the right time.
Quasi-experimental studies have shown that BCMA, when integrated with electronic medication administration records, can reduce medication administration errors by 50% to 80%. However, there is limited data on the use of BCMA in pediatric and outpatient settings. Further research is needed to make conclusive statements about the efficacy of BCMA in reducing medication errors and improving patient safety.
Smart Pumps
Smart pumps are intravenous infusion pumps equipped with medication error-prevention software. These pumps alert healthcare providers when infusion settings are outside pre-configured safety limits.
A randomized controlled trial on the impact of smart pumps on medication safety found no statistically significant difference between activating or deactivating the decision support feature. However, poor compliance of healthcare providers to infusion practices may have influenced the results. Quasi-experimental studies have shown that smart pumps may reduce programming errors but do not eliminate them entirely.
Further research is needed to determine the effectiveness of smart pumps in reducing medication errors and improving patient safety, especially in different clinical settings.
Automated Medication Dispensing Technology
Automated medication dispensing cabinets (ADC) store medication at the point of care and facilitate controlled dispensing and tracking of medication distribution. These cabinets automate medication dispensing, minimize the workload on the central pharmacy, and improve medication tracking and patient billing.
A controlled trial on the use of ADC in a critical care unit found a significant reduction in the rate of medication errors. However, the impact of ADC on patient safety is limited, as there is only one published controlled trial. More studies are required to determine the impact of ADC on medication safety in different healthcare settings.
Retained Surgical Items Prevention Technology
Various technologies, such as barcoding and radiofrequency tagging, are used to prevent retained surgical items. However, there is insufficient clinical evidence to recommend for or against the use of these technologies. They should be considered supplementary to manual counts and not as stand-alone procedures. Further research is needed to evaluate the efficacy and safety of these technologies.
Patient Electronic Portals
Patient electronic portals are secure online applications that provide patients with access to their personal health information and enable electronic communication with their care providers. These portals have been shown to improve outcomes of preventive care and disease awareness and self-management. However, there is limited evidence regarding their impact on patient safety outcomes.
Telemedicine
Telemedicine uses telecommunication technologies to facilitate patient-provider or provider-provider communication. Synchronous telemedicine involves real-time 2-way audio/video communication, while asynchronous telemedicine involves the transmission of patient clinical information.
Systematic reviews have shown that telemedicine is as effective as face-to-face care in specific clinical outcomes. However, there is limited evidence regarding patient safety outcomes. Telemedicine technology seems to improve clinical outcomes, accessibility to healthcare services, and patient-physician collaboration. More research is needed to understand its impact on patient safety.
Remote Patient Monitoring
Remote patient monitoring, also known as telemonitoring, involves the use of technology to remotely monitor patients with chronic conditions. It has been shown to improve patient outcomes for conditions such as heart failure, stroke, COPD, asthma, and hypertension.
Patient data management systems (PDMS) automatically retrieve data from bedside medical equipment and aid healthcare providers in interpreting the data. PDMS has been found to increase time spent on direct patient care, reduce occurrence of errors, and improve clinical outcomes when integrated with clinical decision support systems.
Telemedicine technology and remote patient monitoring appear to improve clinical outcomes and enhance accessibility to healthcare services. However, the impact on patient safety outcomes is not clear and requires further research.
Electronic Incident Reporting
Electronic incident reporting systems allow healthcare providers to voluntarily report safety incidents. These systems can be integrated with electronic health records to automate data entry and analysis. While incident reporting systems may improve clinical processes, there is limited evidence that they reduce medical errors.
Overall Impact of Health Information Technology on Patient Safety
Numerous studies have shown that implementing health information technology, such as electronic medical records, CPOE, and CDS, improves patient safety outcomes. These technologies reduce medication errors, adverse drug reactions, and improve guideline adherence. However, the impact of other technologies, such as electronic sign-out tools, smart pumps, and patient portals, on patient safety outcomes is unclear due to limited evidence.
Healthcare organizations should carefully evaluate the evidence for different health information technologies before investing in them, considering the specific needs and goals of their organization. Continuous evaluation and monitoring of patient safety outcomes are crucial to ensure that the implemented technology achieves its intended benefits.
Conclusion
Health information technology plays a vital role in improving patient safety outcomes by reducing medication errors, adverse drug reactions, and improving compliance to practice guidelines. However, not all technologies have the same level of evidence in improving patient safety outcomes. Healthcare organizations must be selective in their investment in technology, considering the specific needs and goals of their organization. Continuous evaluation and monitoring of patient safety outcomes are essential to ensure the effectiveness of health information technology in improving healthcare quality and safety.
