Patient Safety is the result of practices and policies that healthcare organizations employ to protect patients from preventable harm. A National Health Record would help mitigate some main contributors to patient safety issues, such as medication errors, timely reporting of critical health events and data availability for care teams.
Medication Errors
According to Agency for Healthcare Research (AHRQ) and Quality’s Patient Safety Network (PSNET), “In a review of EHR safety and usability, investigators found that the switch from paper records to EHRs led to decreases in medication errors, improved guideline adherence, and (after initial implementation) enhanced safety attitudes and job satisfaction among physicians.”
In addition to the obvious benefit of having all information in one place, I am certain patients, especially the most vulnerable ones, would benefit greatly through reduction in medication errors. A standard Drug Utilization Review (DUR) could expand to every medication the patient is on instead of only the ones in the providers Electronic Health Record (EHR). The DUR looks at drug-to-drug contraindications, drug-to-disease or allergy complications, duplicative treatment, high or low dosage, as well as factoring in drug-age, drug-gender and drug-pregnancy precautions. If medical providers and pharmacists had a comprehensive list of medications prescribed to the patient, the value of the DUR would be exponentially greater than relying on the local EHR. All of this would contribute to improved treatment and reduced complication caused by the current localized electronic collection of data.
Critical Timely Knowledge of Events
Currently, managing the downstream effects of medical events, such as hospitalization, Emergency Department visits and readmission, are reliant on coordinated care between unrelated healthcare entities and self-reporting by the patient and family. As insurance consumers have moved toward PPO plans over coordinated HMO healthcare plans, the heavy burden for communicating medical events to a PCP and other providers rests with the patient. This puts the patient’s safety at considerable risk. The need for timely, clear and accurate communication of the incidents, the care given before, during and after, as well as the data that supports future treatment plan is critical to ensuring patients are not harmed by the care they are receiving.
Preventable Adverse Events are defined as: harm to a patient caused by the medical they receive, not from their actual condition, illness, injury or disease. Human error contributes to the prevalence of adverse events, but inadequate and timely data are critical to off-set the number of incidents. Again, the availability of a National Health Record would mitigate this costly, preventable danger within our healthcare system.
Care Team Support
Outside the day-to-day benefits of a National Health Record, there are long-term patient safety benefits related to clinical decision support. EHRs either have built-in clinical decision support or have the ability to buy plug-and-play modules. These packages provide care teams with best practices at a general level, but can also be personalized based on a patients’ medical history, medications, as well as the ability to incorporate family medical history, to take advantage of any genetic and genomics data that can strengthen the quality of their care. Having timely, comprehensive information alongside a personalized approach for a care team will support sound decisions, help avoid adverse events and help improve outcomes for patients.
Reducing preventable re-admissions is one area I think would benefit greatly from care teams having better clinical decision support. By assessing patients risk for readmission based on comprehensive patient data alongside best practice, the care team can proactively create discharge plans that focus on known issues that lead to readmission. The additional data that comes from external providers for an individual patient will bolster decisions provided from clinical decision support libraries. Simply put, the more information to feed into a decision support tool, the better the recommendations will be.
A Case Study in National Health Record
In 2016, Australia implemented My Health Record, the nation’s National Health Record. Some of the benefits they have experienced:
- Prevent adverse drug events, reduce medical errors, improve vaccination rates, better coordinate care and better inform treatment decisions
- Sustain a more efficient health system, through less time searching for patient data, reduction of avoidable hospitalizations, and reduced duplicated pathology tests and x-rays which inconveniences patients and increases the cost of healthcare
- Improve patient experience by putting the patient at the center of their healthcare, and keeping people out of hospital
- Provide greater access to healthcare for people living in rural and remote areas of Australia
- Protect the national digital health infrastructure and secure the personal health information of Australians
As mentioned in my previous blog, four major factors contribute to The Need for a National Health Record: collecting comprehensive information, supporting the role of patients as consumers, having the ability to care for our vulnerable populations and improving patient safety. In my opinion, our entire healthcare system and all who participate in it would quickly see the value on a financial, human and industry level. Australia has proven its worth, and has succeeded in showing that the value far outweighs any perceived risks and concerns.
