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Safety and risk under the microscope

Safety and risk under the microscope

How effective are new clinical and patient administration platforms at achieving goals that many in the sector believe are a given? Study attempts to provide the answer.

Hospitals and governments around the world are spending hundreds of millions, if not billions, of dollars on powerful information systems that are expected to play a central role in reducing medical errors. But surprisingly little is known about exactly how effective new clinical and patient administration platforms are at achieving goals that many in the sector believe are a given.

Academics at the University of Sydney, however, plan to answer those questions and more with a three-year study that will attempt to prove whether or not e-health provides the answers to improving hospital care here and overseas.

"Internationally we have big problems in the area of patient safety and errors, and these systems are particularly thought to be good at helping to reduce errors," says University of Sydney health informatics professor Johanna Westbrook.

"There are a lot of logical reasons for believing that - for example, if you go from a handwritten medication order to a printed order, the order is easier for people to read.

"So, logically, that should translate into less errors, but when you look at these systems overseas, there isn't a lot of evidence to show they really do reduce the most severe types of mistakes."

Clouding the picture further is the way many e-health systems are developed. Often hospitals will custom build software to target problems specific to an individual health-care provider.

That's not the case, however, with off-the-shelf systems, which are more cost-effective for hospitals but may not provide the same results.

Westbrook also says there is very little data on the rate of errors in hospitals, although some estimates suggest as many as 80,000 Australians are made ill or killed by medication errors each year.

That means University of Sydney researchers have spent the first 18 months of the study developing a baseline against which they can measure the effects of e-health systems.

In particular, the research is looking at medication management and electronic decision-support software that is becoming much more popular in Australian hospitals.

Westbrook adds that because so little is known about how the majority of medication errors occur, it's difficult to say what benefits e-prescribing might have.

"One of the things we are looking at for the medication administration study is interruptions to clinical work," she says. "In a published study, we have shown that of all the work tasks we've observed nurses perform, they are most likely to be interrupted when they're preparing and administering drugs. That's quite startling actually.

"But we don't know whether the interruptions lead to errors, and that's what our study will be able to say."

The study will also examine the extent to which the introduction of electronic health systems creates new types of mistakes.

"There are a few studies internationally that have demonstrated these systems generate their own errors," Westbrook says.

"If you imagine a doctor is ordering a drug from a drop-down menu and they are interrupted, they could actually click on the drug above or below the one they wanted.

"What we're trying to do is get a much more systematic approach to determining the frequency of these types of errors so we can use that evidence to better design or modify these systems."

To that end, a number of major hospitals are participating in the University of Sydney study and are eagerly awaiting the results.

Westbrook says the industry is convinced e-health will provide positive results, but also has a hunger to learn how to maximise those benefits for patients.

"I think there is a lot more we could know about how we could get greater benefits from these systems by doing fairly minor modifications," she says.

"There's often a great desire to just computerise existing paper-based systems and the way things are done, but really the potential of many of these systems is to help us look at different ways of providing care."

Fairfax Business Media

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