Get ready: Mandatory medical error reporting is on the way
Get ready: Mandatory medical error reporting is on the way
HIM professionals should begin collecting error data now
Mandatory reporting of medical errors is just a "quick-fix" effort at a greater problem and will only create fear among health care providers.
That’s what health care advocacy groups such as the American Medical Association and American Hospital Association argue in light of President Clinton’s plan to impose mandatory error systems within the nation’s 6,000 hospitals participating in Medicare. The administration argues that the plan will cut medical errors by 50% over the next five years and will provide peer review protections for providers, but the effort is doomed from the start, critics contend.
"Something will come that will have a mandatory reporting component," says Kenneth Kizer, MD, MPH, president and CEO of the National Forum for Health Care Quality Measurement and Reporting, also known as the National Quality Forum, in Washington, DC. The Quality Forum is a not-for-profit membership organization created to develop and implement a national strategy for health care quality measurement and reporting.
The Clinton administration, working in conjunction with the National Quality Forum, outlined a goal in late February to have all 50 states on a mandatory reporting system within three years for preventable medical errors that cause death or serious injury, and voluntary reporting of other mistakes.
Additionally, a set of patient safety measurements will be developed "that would lay the foundation for a uniform system of reporting errors," Clinton said in announcing the plan.
Other elements of Clinton’s plan include:
- Establish a $20 million Center for Quality Improvement in Patient Safety to develop national quality improvement goals, issue an annual report on the state of patient safety, and translate its research findings into better practices and policies for the health care industry.
- Force hospitals that participate in Medi-care’s prospective payment system to have or institute patient safety programs to prevent medical errors. "These new systems save lives, and over time of course, also save money," Clinton noted.
- Charge the U.S. Food and Drug Admini-stration to develop standards to prevent medication errors caused by misleading packaging of drugs or sound-alike drug names. The administration also plans to develop label standards that highlight common drug interactions and dosage errors.
Now HIM can help
There’s good news despite the legal implications, experts say. Health information management professionals who work in quality or risk management already have a significant role in the recording of medical errors. But HIM professionals who work in the HIM or medical records departments can play a role, too.
The HIM department people easily can be screening records to identify adverse events. "They can serve in a safeguard role to make sure things get reported — theirs is the last stop before the record goes into the final file in the medical records department," says Patrice Spath, RHIT. Spath is a consultant in health care quality and resource management with Brown-Spath & Associates in Forest Grove, OR.
"They can be given criteria to look for in the records to help identify adverse events. By keeping a log of those, the quality manager or risk manager can match up that log with the incident reports to make sure they have all the reported incidents. Some HIM departments are already doing that," she adds.
Coders also can help by using a code that indicates an adverse event, when applicable. "That code then goes into an information system. The risk manager or quality manager, if people are coding things as they should, should be able to pull out the incidents of these types of adverse events from that information system." By doing a thorough job of coding adverse events, the coders are helping create a better information system that can be used to identify them, Spath says.
HIM professionals also should consider the use of software to help reduce medical — and particularly medication — errors. This kind of software has both advantages and disadvantages, Spath says.
One advantage is that it can give users access to information that lets users make better decisions, she says. "For example, if a physician orders a medication that should not be used in conjunction with some of the patient’s other medications, the system might send a warning to the physician."
Software also can halt the process, Spath says. The program can ask "Are you sure?" questions that make the user stop and consider what he or she is doing. "That’s how computers help."
Software, however, can introduce a new potential for errors into the process of patient care, too. "One of the things that can easily happen is that we think the computer is always right, and we quit thinking," Spath says. "If the computer says it is OK to give the patient’s medication, then it must be. We give the medication without thinking about some of the other things that maybe the computer isn’t aware of.
"[Software] can’t take the place of human critical thinking when things don’t go as normal," she warns. "Every contingency can’t be built into the system."
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