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Imagine that we had an airline crash every day, taking the lives of more than 250 Americans. The country would be outraged, the president would be demanding action, and Congress would be passing emergency legislation. And yet a tragedy of similar proportions is occurring right now in American hospitals.
As many as 98,000 people are needlessly dying in our hospitals every year because of inappropriate medical treatment, according to the report “To Err Is Human” by the Institute of Medicine (IOM). The number of people who die every day in hospitals because of inappropriate medicine is double the number who died in last week’s Concorde crash.
The time has come for Congress and the president to act on behalf of all Americans. It is time to stop defending inefficiency and to drag health care into the 21st century by insisting on modern management and information systems.
According to IOM’s initial report, inappropriate medical treatment is the fifth leading cause of death in the United States. And that number does not include deaths resulting from home care, ambulatory care or outpatient visits, those that occur in nursing homes or those at patients’ homes after they have received inappropriate care in the hospital.
Nor does it encompass deaths from genuine malpractice. The term “inappropriate medicine” refers to an action undertaken by a doctor, nurse or other member of the medical team that has an unintended destructive outcome but is not the result of negligence. It is a well-meaning action by a well-meaning person leading to a bad result–in the most extreme cases, death.
How can this be happening in our medical system, the best in the world? One of the most common causes of inappropriate deaths is the prescription of the wrong medicine. Many doctors write illegibly, and pharmacists subsequently make errors trying to read the handwriting. The other major cause of prescription errors is ignorance by a doctor about other medications a patient may be taking, or about the patient’s allergies.
The answer to this problem–responsible for 19,000 or more deaths a year in hospitals–is simple and obvious: Every prescription should be electronic, and every patient should have an electronic medical record. The prescription should be compared with the medical record and, if it is inappropriate, the doctor ought to receive instant electronic notification. A system of this kind is not only easily within the reach of an Internet-based technology, the products are already on the market. Companies like ePocrates and iScribe give away hand-held electronic devices to doctors for this purpose.
Some critics argue that electronic systems exchanging personal medical information cannot guarantee privacy. Although I believe in the sanctity of medical information, I am confident designers can develop systems that meet security requirements for electronic data flow.
For example, every time you use an ATM to get cash out of your personal checking account, you send information about your bank account over the Internet. This proves that we can build the security to keep records safe and that we can accurately identify people and their records.
Beyond electronic prescriptions, there are other glimmers of hope that we can make real progress toward safer, better health and health care. Merck-Medco runs a facility in Las Vegas that is the most efficient and safe prescription center in the world. It has filled 50 million prescriptions without a single error, because it was designed from the ground up to be accurate and safe using available technology.
The Veterans Administration’s Palo Alto Health Care System is creating a computerized patient medical record system. The new Northwestern Memorial Hospital in Chicago was designed from its conception to be a safer, more accurate and more electronic facility. Don Berwick at the Institute for Healthcare Improvement has worked for years to spread the word that the same systematic approach to quality control that has worked so well in manufacturing could create a dramatically safer, less expensive and more effective system of health and health care.
Yet the overall picture in health and health care is of a field that is reluctant to improve its systems to incorporate the lessons of the Internet, of quality control, of systematization and of computerization. The decision to make systemic changes will happen only under strong leadership. It is appalling to witness the passive and even defensive reaction of some health care executives, care providers and administrators to the IOM report on deaths by medical error.
Any airline manager who defended a status quo in which an airliner a day crashed would be out of work. We would correctly insist that safety transcends profits, management styles, corporate cultures, pilots’ preferences, fears about privacy or any other excuse to avoid change.
We cannot wait. A first step: Congress should pass a bill requiring that within three years every doctor’s prescription and every patient’s record be computerized, with appropriate privacy safeguards. These and similar reforms to follow in many areas of hospital health care will not only save huge amounts of money. They will save tens of thousands of lives every year.
Newt Gingrich, a former speaker of the House of Representatives, is a senior fellow at the American Enterprise Institute.
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