Lisa Pizziferri

Detecting Adverse Events Using Information Technology

CONTEXT Although patient safety is a major problem, most health care organizations rely on spontaneous reporting, which detects only a small minority of adverse events. As a result, problems with safety have remained hidden. Chart review can detect adverse events in research settings, but it is too expensive for routine use. Information technology techniques can detect some adverse events in a timely and cost-effective way, in some cases early enough to prevent patient harm. OBJECTIVE To review methodologies of detecting adverse events using information technology, reports of studies that used these techniques to detect adverse events, and study results for specific types of adverse events. DESIGN Structured review. METHODOLOGY English-language studies that reported using information technology to detect adverse events were identified using standard techniques. Only studies that contained original data were included. MAIN OUTCOME MEASURES Adverse events, with specific focus on nosocomial infections, adverse drug events, and injurious falls. RESULTS Tools such as event monitoring and natural language processing can inexpensively detect certain types of adverse events in clinical databases. These approaches already work well for some types of adverse events, including adverse drug events and nosocomial infections, and are in routine use in a few hospitals. In addition, it appears likely that these techniques will be adaptable in ways that allow detection of a broad array of adverse events, especially as more medical information becomes computerized. CONCLUSION Computerized detection of adverse events will soon be practical on a widespread basis.

Opportunities to enhance patient and physician e-mail contact.

The purpose of our study was to evaluate how e-mail is currently used between physicians and patients in an integrated delivery system, and to identify developments that might promote increased use of this form of communication. A paper-based survey questionnaire was administered to 94 primary care physicians. We evaluated the role e-mail currently plays in a physicians typical work day, physician views on the impact of e-mail on phone use and the barriers to increasing the use of e-mail with patients. 76% of physicians surveyed responded. All respondents currently use e-mail. Close to 75% of physicians use e-mail with their patients, but the vast majority do so with only 1-5% of those patients. 50% of physicians believe that up to 25% of their patients would send e-mail to them if given the option, with an additional 37% believing that between 25% and 50% of patients would value this option. The main reported barriers to physician-patient e-mail related to workload, security and payment. Our survey findings indicate that with adequate pre-screening, triage, and reimbursement mechanisms physicians would be open to substantially increasing e-mail communication with patients.

Policy and the Future of Adverse Event Detection Using Information Technology

In health care today, most adverse events are detected using spontaneous reporting, which identifies only a small number of adverse events.1 This is probably the major reason that problems with patient safety have been overlooked until recently. However, information technology can be used in a variety of ways to detect adverse events continuously and relatively inexpensively. In an accompanying paper,2 we review the methodologies for detecting adverse events using information technology and the evidence regarding their efficacy. This editorial presents some of what we believe are future possibilities in this domain and discusses policy issues regarding the development of strategies that may result in wider use of such tools. Spontaneous reporting is attractive because it is inexpensive compared with other approaches for detecting adverse events. Events detected via this route can be useful for quality improvement. However, because reported events represent only a tiny fraction of all adverse events that occur, absolute rates of spontaneous reporting or changes in them are not particularly useful, except to assess safety culture or whether strategies to improve reporting have worked.3 In …