The Best Prescription for Eliminating Medical Errors

Everyone acquainted with the subject knows that preventable medical errors are a major problem in health care, perhaps even the eighth leading cause of death in the United States.  The ongoing challenge is how to respond to them. 

Most experts agree that Clinical Information Systems (CIS) represent a core solution, providing a technological compass for guiding best-practices medical care and preventing both diagnostic and treatment errors.

But, in our opinion, Clinical Information Systems alone are not a sufficient solution.  We believe hospitals today require a comprehensive, integrated organizational system, which we call a Transformation Model.  Furthermore, we believe that reducing medical errors is important but not sufficient.  There are other issues equally critical to the successful operation of a quality medical institution that require attention, including: eliminating waste, eliminating unnecessary variance in care delivery and eliminating delays.  The Transformation Model employed by Cerner Corporation, which my Partner Rick Smithdeveloped while leading Cerner Consulting, addresses all of these issues simultaneously and, if properly implemented, will dramatically improve the Healthcare qualitydelivered by our nation’s hospitals.

To envision how our model works, picture a baseball diamond.  Around this diamond are five key “players,” all of which are necessary for a high-performance operation. On the pitcher’s mound is the Clinical Information System itself. In the position of home plate, you’ll find Workflow Optimization.  On first base is Knowledge; playing second base is Technology; and on third base is Culture.  Recognizing the strengths and talents of the individual “players” – and the need for their finely synchronized coordination -- are as essential to the functioning of a best-practices medical facility as they are to the success of a world class baseball team.

A description of our five core “players” follows:

• The Clinical Information System (CIS) is the heart and soul of the operation, providing the means by which all information is captured, stored and exchanged among healthcare professionals. This includes, for example, the key medical record facts that can help prevent drug-drug interaction errors, prevent physicians from ordering the wrong dosage, or prevent nurses from administering the wrong medication.  There are many systems on the market today, but none of them, in isolation, will resolve the problems in question.

• Workflow Optimization:  Workflow applies to all of the activity that takes place in and around the medical process—from drug administration to surgical planning to outcomes measurement, etc.  While the CIS radically changes the way all tasks are executed, workflow optimization assures elimination of waste and delays. 

• Knowledge, or rather, we should say the knowledge that is embedded in the CIS.  This embedded knowledge empowers “evidence-based” medicine – or best practices based upon hundreds of thousands of patient experiences.  A physician can pinpoint situations that match the profile of the patient in question and determine the best treatment that will achieve the best possible outcome.   Such a system augments our current standard -- “memory-based” medicine – which relies on the recall potential of the human brain to assemble the often puzzle-like pieces of medical histories, symptoms and treatment paradigms to arrive at the precise course of action.   Care givers have immediate access to the best and most accurate treatment options, and patients not only receive expert care, they are also spared unnecessary expense.

• Technology:  An automated Clinical Information System is of little help unless it’s easy for physicians to access.  It must be simple to operate and portable, so it can be used in the hospital or office, at home or on the road.  New handheld devices and smart electronics and their underlying networks make information available in a convenient and timely fashion. 

• Culture:   The fifth and arguably most important player is culture. The ultimate success of a Clinical Information System relies on how well it is integrated into the culture of the organization and made a living, breathing part of everyday life.  To do this correctly requires creating an environment that emphasizes  reducing medical errors and eliminating waste as mission critical.  Also core to adopting these systems is recognizing that like all new technologies they will require a period of adjustment and adaptation on the part of the users.  Incorporating a clinical information system into a hospital setting promises to be similar in impact to the introduction of automatic teller machines (ATMs) to banks more than 20 years ago.  ATMs took upwards of ten years to be accepted, and even still today one can hear rumblings of dismay over their existence.  Clinical information systems won’t be embraced overnight.  But here’s one piece of important advice to help your organization accelerate its adoption:  be mindful of helping physicians – your number one constituent -- recognize the value they will derive from the system.  Speak in terms they prize most: time saved, improved patient success and satisfaction rates, reduced insurance costs, and enhanced income. 

Few organizations have achieved any level of success with Clinical Information Systems, even though the fundamental systems have been around for many years.  This is a testament to the difficult challenge their successful integration represents. The good news is the Transformation Model does work and there are professionals with a track record to help your organization effect a smooth and successful adoption.