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Medical errors cost $1.5 billion a year -- in Illinois alone --
contributing to higher insurance premiums, higher costs for hospital
visits and treatments, higher co-pays, higher insurance rates for
doctors, and higher costs of prescription drugs. At Evanston
Northwestern Healthcare on Thursday, the governor proposed that all
providers use "e-prescribing" to reduce errors and save time and
money by eliminating paperwork. E-prescribing, or computerizing
prescriptions, would mean doctors could easily see what other
medications the patient is taking so there are no allergic reactions
or other interactions, and then send the prescription to the
patient's pharmacy electronically to avoid mix-ups.
"When you go to the doctor, you expect to get the care you need,"
Blagojevich said. "And doctors and hospitals want to give you the
care you need. Your confidence shouldn't be undermined because
you're worried about someone making a mistake. And your health
certainly shouldn't be compromised because someone does make a
mistake. What types of mistakes are we talking about? Nothing
intentional and nothing malicious. Just mistakes like prescribing
one medication and dispensing another, or not properly cleaning
surgical instruments, which can lead to infections. If you think
about it, it's not that surprising that mix-ups occur when it comes
to prescribing and dispensing medicine. Doctors are already famous
for their bad handwriting. Add on top of that all of the medicines
that look alike or sound alike but do very different things. So the
fact that doctors sometimes prescribe medicine for one problem and
the patient ends up taking medicine for another problem isn't that
unusual. That's why I'm proposing that we enable every doctor, every
medical provider in Illinois to prescribe medicine electronically.
That means doctors will be able to see what other medications the
patient is taking so there are no allergic reactions and no drug
interactions, and then send the prescription to the patient's
pharmacy electronically."
Every year, 98,000 Americans die from medical errors -- errors
that were preventable. In fact, nearly as many Americans die each
year from medical errors as from AIDS (16,500), breast cancer
(42,000) and car accidents (43,000) combined.
On Thursday, Blagojevich proposed a comprehensive package of
reforms to reduce the number of medical errors and improve patient
safety. The package includes:
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Proposing that all
providers use e-prescribing by 2011 to reduce the risk of
medication-related errors.
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Creating a
Division of Patient Safety within the Illinois Department of
Public Health to specifically focus on reducing medical mistakes
and improving patient safety.
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Directing the new
Division of Patient Safety to develop standardized medication
practices to reduce adverse drug effects.
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Directing the
Department of Financial and Professional Regulation to complete
an online physician database so patients can learn more about
their doctors.
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Directing the
Department of Public Health to expand its nursing home database
to help seniors and their families learn more about each
facility.
E-prescribing allows physicians to access information about
medications the patient may be taking, any potential interactions or
allergies, and whether the drug is in the patient's health care
formulary. Physicians would then electronically send prescriptions
to the patient's pharmacy. The e-prescription can be received by
participating pharmacies as an e-mail or fax. Either way, the
pharmacist receives the information in a legible format, minimizing
the risk for errors. The electronic script can automatically be
checked for potential errors, such as an inconsistency in the
prescribed dosage or duplicate therapies. If the program can access
the patient's insurance formulary, the billing process could be
streamlined.
Computerized prescriptions are shown to have reduced errors by 80
percent, according to the Journal of the American Medical
Association. There are 750 different medications that look and sound
alike. For example, Lamictal and Lamisil both look and sound
similar; however, Lamictal is an antiepileptic drug and Lamisil
fights fungus. Other errors have occurred in mix-ups of Celebrex,
which treats arthritis; Cerebyx, an anticonvulsant; and Celexa, an
antidepressant. With so many similarly named medications, and with
doctors' famed illegible handwriting, these types of mistakes do
happen.
The Institute for Safe Medicine Practices estimated that
pharmacists place more than 150 million calls each year to
physicians asking for clarification. More than 3 million of the 8.8
million adverse drug events in ambulatory care are preventable,
according to the institute. These errors result from illegible
handwriting, unclear abbreviations and doses, unclear telephone or
verbal orders, and ambiguous orders, according to the institute.
For doctors and hospitals that already have a secure,
Internet-based system -- like Evanston Northwestern Healthcare,
where the governor made the announcement -- the state will make sure
that each system meets the same standards and that these standards
adhere to any federal standards. For doctors and hospitals in
underserved communities that do not have such systems, the state
will help develop programs and access the technology needed so that
all prescriptions can be computerized.
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The state will work to identify gaps in access to the hardware,
software and training needed to computerize prescriptions. The state
will also help expand the technology networks that health
professionals need to send prescriptions and exchange medical
information electronically in a safe way. The governor issued an
executive order Thursday to create the Division of Patient Safety
within the Department of Public Health. This new division will
consolidate the state's efforts in dealing with medical errors and
will focus specifically on improving patient safety, with the goal
of reducing errors.
To accomplish the goal of e-prescribing by 2011, the new Division
of Patient Safety will immediately begin exploring:
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Where the need for
technology exists.
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What kind of
technology is needed -- Internet platform, computers, etc.
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How much it will
cost to provide and maintain that technology.
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What outside
funding is available to the state and providers to build this
technology.
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How to assist
providers who may not use computers in their practice.
In addition to implementing e-prescribing, Blagojevich directed
the Division of Patient Safety to work with the Department of
Financial and Professional Regulation, the Illinois Department of
Healthcare and Family Services, and organizations of physicians,
researchers, pharmacists and other health care providers to issue
recommended medication practices to all providers.
According to the Journal of the American Medical Association,
standardizing prescription practices reduces adverse drug effects by
60 percent. This can include such practices as:
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Adhering to black
box warnings placed on prescriptions by the Food and Drug
Administration to indicate that the medication may have a high
risk for certain populations, such as antidepressants in
children.
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Paying attention to
"high-alert" medications that have a heightened risk of causing
significant patient harm when used in error.
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Identifying a list
of "error-prone abbreviations" that are frequently
misinterpreted and involved in harmful medication errors.
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Paying attention to
the "do not crush" list of drugs that when crushed or split
incorrectly could cause harm to a patient.
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Paying attention to
the list of drugs with names that are often confused.
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Providing
guidelines to prevent medication errors in children.
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Improving
prescription drug labels to be more clear and user-friendly.
The new Division of Patient Safety will also explore:
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Creating a
prototype for electronic medical records for hospital patients
in Illinois.
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Helping rural
health facilities get access to broadband technology.
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Expanding the use
of telehealth and telepharmacy so that rural health facilities
can work with urban facilities to provide information and care.
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Creating a patient
navigator program to provide non-Medicaid patients with
individualized assistance and care.
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Providing
low-interest loans, through the Illinois Finance Authority, to
physicians to purchase technology so they can access medical
databases and patient information.
Blagojevich also directed the Department of Financial and
Professional Regulation to expand Illinois' online physician
database. The current database is technical and difficult to
navigate. A user-friendly database would provide easily accessible
information about a physician's board certification, education,
residency, practice, legal actions, expertise and experience in
particular procedures.
Additionally, the governor directed the Department of Public
Health to expand the state's nursing home database to make it easier
to understand and to provide information on available services. The
database would help consumers evaluate the type of care offered by
nursing homes that are licensed and certified by the state. By
quantifying different measures like staffing ratios, medication
distribution, on-site services and citations against a facility,
people can know what type of facility they or their loved ones are
using and make informed decisions.
"These are just some of the steps we can take to cut down on
medical errors and help keep patients safe," Blagojevich said. "If
we're successful, our patient safety plan will save money because it
will reduce the costs that come with treating medical errors. But
far more importantly, it will save lives. Because at some point, we
all go to the doctor. At some point, most of us go to the hospital.
And at some point, most of us go to the pharmacy. Knowing that the
medicine we receive is the right one and knowing that we've
addressed the common causes of medical errors means peace of mind
for doctors, for nurses, for pharmacists, for hospitals, and most
importantly, it means peace of mind, and better care, for all of
us."
[News release from the governor's
office] |
