Bills aim to cut errors by boosting doctor communication

Better electronic medical records and efficient dissemination of best practices are two goals.

By Michael J. Bernstein, AMNews correspondent. Oct. 14, 2002. Additional information

Washington -- When it comes to legislation to reduce medical mistakes, the question of how to develop an error-reporting system has taken center stage over the past few years. But bills wending their way through Congress also contain provisions on a much less glitzy topic -- information sharing -- that could have a major impact on physician practices.

Two virtually identical House measures would require the federal government to develop voluntary, national information-sharing standards to ensure that doctors in all settings can have easy access to the most current information about treatment and diagnosis.

The goal is to develop uniform computer programs that could be readily accessed by all doctors. For example, one aim is to have improved electronic medical records and prescriptions.

Drafters of the legislation also said improved computerized information systems would benefit doctors by reducing paperwork, as well as eliminating redundant record-keeping, medical tests and patient history-taking.

The enhanced information system not only would inform doctors about medical errors, but would also provide them with an easy way to learn about the best current practices and the latest research breakthroughs.

To address the information exchange issue, the House bills would create a Medical Information Technology Advisory Board within two years. The board would be composed of a variety of experts -- from clinicians to government officials to information technology specialists.

It would have 30 months to issue a report recommending the best means of developing computer programs that would contain uniform, clearly written medical information programs for doctors in private practice and in hospitals. Additionally, the report would spell out how to keep medical records secure under any new computer system that enables doctors to share information about patients.

Improving the process for exchanging medical information is critical to reducing the number of medical errors, said Susan Dovey, PhD, an analyst at the Robert Graham Center, Washington, D.C.

"The primary concern of practicing physicians is with information management -- sorting out patients with ill-defined symptoms and deciding how to treat them," said Dr. Dovey, lead author of a study categorizing medical errors published in early September in Quality and Safety in Healthcare. The "sheer volume of information coming from labs, insurers and other physicians" is mind-boggling, she added.

The answer to the problem is to improve physicians' personal communication skills and computerized communication systems so that practices have access to as much current medical information as possible, Dr. Dovey said.

According to Donald M. Berwick, MD, president and CEO of the Institute for Healthcare Improvement, health professionals aren't using the best medical practices because not enough current medical information is reaching them.

The processes whereby doctors and others obtain their medical information are inefficient, outdated and not capable of reporting the rapidly growing mountain of new medical information to them clearly and promptly, he said.

"There is a deluge of scientific information, and there is a mystical view that physicians are able to process all of it," Dr. Berwick said. "If travel agents acted the way doctors do, they would be memorizing all of the flight schedules."

He advocates development of a standard electronic patient-records system designed to provide information useful to hospital staffs and small private physician practices. Large health care systems have already developed the means to inform staff about which medical procedures work and which don't, he said.

The legislative front

In September, the medical error bills passed in two House committees. At press time, the legislation awaited consideration by the full chamber.

In addition to improving information sharing, the measures are designed to improve quality by encouraging physicians and others to voluntarily report errors and near misses to patient-safety organizations. The PSOs would analyze reported errors, offer feedback to prevent future mistakes and catalog the findings in a database that would show national trends in medical mistakes.

The bill passed by the House Ways and Means Committee has drawn strong backing from many health care groups, including the American Medical Association and the American College of Physicians--American Society of Internal Medicine.

"This clearinghouse effect for information on medical errors will give practitioners the ability to learn from others' mistakes," said AMA Trustee Timothy Flaherty, MD. "This can lead to an exploration of solutions by sharing experiences with medical errors."

The Bush administration also supports the bill.

The various measures are the latest of several congressional efforts to address the problem of medical errors spurred by the 1999 Institute of Medicine report. It estimated that up to 98,000 patients a year die from medical errors and that this problem costs the nation $37.6 billion a year.

Previous efforts became bogged down in debate over whether information on medical errors could be used against doctors and hospitals in medical malpractice cases or other proceedings. The same issue is putting full congressional passage in doubt again this year.

Sen. Edward Kennedy (D, Mass.), chair of the Health, Education, Labor and Pensions Committee, opposes the Senate voluntary error-reporting bill's confidentiality language. He said the House and Senate measures don't properly balance encouraging reporting of medical errors with maintaining legal remedies for patients.

The House and Senate bills state that any reported patient-safety information would be "privileged and confidential." That is, information on reported errors could not be used against doctors or other health care workers in civil or administrative actions, such as disciplinary, malpractice or other civil proceedings.

The American Medical Association and ACP-ASIM have generally supported the confidentiality language, agreeing that it would adequately protect health care professionals and encourage them to report errors.

The AMA, however, has urged that the House bills extend this protection to criminal cases, as the Senate bill does with limited exceptions.

ADDITIONAL INFORMATION:

Patient safety stances

The House and Senate patient safety bills generally cover the same ground but have some differences.

Who would be affected: The House version would require doctors, hospitals and other health organizations who participate in Medicare to voluntarily report medical errors. The Senate bill would not restrict reporting to only those participating in Medicare.
Impact on state laws: The House version would not preempt or affect any state mandatory error reporting law. The Senate bill's voluntary reporting language would preempt such mandatory requirements.
Patient safety database: The House bill would require creation of a patient safety database. The Senate version would make such a project voluntary.
Technology advisory board: The House version calls for creation of a Medical Information Technology Advisory Board that would report on the best practices in medical information technology and recommend methods of implementing these practices. The Senate bill does not create such an advisory group.

GOVERNMENT & MEDICINE