IT solutions for IV errors

FRAMINGHAM (02/26/2004) - In December 1994, a fourfold chemotherapy overdose killed 39-year-old Betsy Lehman, a breast cancer patient at the renowned Dana-Farber Cancer Institute (DFCI) in Boston, and, ironically, a health columnist for The Boston Globe.

Her highly publicized death at one of the nation's top cancer research hospitals was a tragedy of errors that put medical blunders under intense scrutiny. The incident still resonates through DFCI's hallways, although a search of her name at www.dana-farber.org yielded zero hits. However, her loss was remembered in January when the Massachusetts Department of Public Health created the Betsy Lehman Center for Patient Safety and Medical Error Prevention.

A shocked medical community asked how this could have happened at a prestigious institution such as DFCI, which was recently ranked the fourth best cancer center in the United States by a top news magazine. At last count, 528 clinical trials were under way there with partner Harvard Cancer Center. And it receives about US$165 million in research funds annually.

Predictably, the experience has made DFCI a living, breathing advertisement for patient safety and IT.

"Dana-Farber has embraced a culture of safety because of (Betsy Lehman's death)," said DFCI president Edward Benz, in a recent interview. "You have to have the right information about every patient in the hands of every caregiver who touches that patient." DFCI has created numerous job positions and organizations to reduce the chances of another lethal chemotherapy overdose.

All well and good, but Benz makes a key point: "You immediately jump to IT solutions because you know (the job) cannot be done by humans alone." However, the right information about every patient does not happen at the snap of someone's fingers -- even though that is the goal.

So DFCI has adopted electronic chemotherapy order entry and is nearly finished launching electronic medical records (EMRs) for the thousands of patients it treats every year. "One of the re-examinations that happened after the overdose caused us to form a joint venture with Partners (HealthCare System), and now we work together on common information systems. That's allowed us to implement longitudinal medical records and chemotherapy (order entry)."

EMRs shouldn't happen just at places of thought leadership like DFCI. There's a no less urgent need for them at clinical practices of all kinds. One of the first things you notice entering my physician's office are canyons of manila medical folders. Little wonder the folks running the office are overwhelmed. My doctor recognizes the need for his four-physician practice to go electronic, but estimates the cost of conversion to be around half a million dollars. That was high, I told him, and explained he could start in stages at a fraction of that.

Cost isn't the only barrier, Benz says: "It's been very hard to get off the bus, stop and say, 'We've got to blow this up and re-invent it.' The systems we've created have been by patchwork, ad hoc retrofitting, and reverse engineering rather than by going forward with a clean-sheet design approach."

Of course, we can't blow up the current healthcare system. But the government and private payer community can start offering positive incentives to those who make IT investments. "You're motivated to improve (IT) because if you don't, your days in arrears are going to skyrocket. There's perverse incentives because the longer you take to pay the bill, the less you have to pay if you're a payer."

What's needed, Benz says, is something akin to the Hill-Burton Act of 1946, which guaranteed virtually every citizen the right to basic healthcare. Before that, the notion of public health as we define it today did not exist. "The Hill-Burton Act led to enormous improvements in the facilities for hospitals. A Hill-Burton type of approach to IT infrastructure (would) at least do the best job of retrofitting," he says.

Would such legislation avoid more reckless mistakes? The best answer is never having to consider the question.

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