Medical-Records Technology Can Promote Patient Safety


WASHINGTON — Health information technology's greatest potential contribution to patient safety lies in areas related to record keeping and record retrieval, David N. Gans said at a conference sponsored by the National Patient Safety Foundation.

“Adding technology gives you the opportunity to improve patient safety,” but the technology must be used properly for there to be an impact, said Mr. Gans of the Medical Group Management Association.

Medical groups that reorganize their work flow will see the greatest benefits from health information technology. Ideally, hospitals, pharmacies, and insurers will be able to integrate information and coordinate their systems, he said.

But many medical practices have not fully embraced electronic health records (EHRs) or other types of health information technology as a way to improve patient safety.

To find the extent to which medical groups implement safety practices with and without technology, Mr. Gans and his colleagues surveyed 3,629 medical groups that had completed the Physician Practice Patient Safety Assessment (PPPSA; Health Affairs 2005;24:1323–33).

The goal of the PPPSA is to provide information that medical groups can incorporate into procedures that will improve patient safety.

The PPPSA was developed by the Medical Group Management Association's center for research, the Health Research and Educational Trust, and the Institute for Safe Medication Practices.

The assessment consists of 79 questions related to patient safety in six areas:

▸ Medications (17 questions).

▸ Handoffs and transitions (11 questions).

▸ Surgery and invasive procedures, sedation, and anesthesia (6 questions).

▸ Personnel qualifications and competency (10 questions).

▸ Practice management and culture (22 questions).

▸ Patient education and communication (13 questions).

For each question in these six domains, respondents can choose from among five answer choices ranging from “unaware or aware but no activity to implement” to “fully implemented everywhere.”

Overall, more than 70% of the groups surveyed used paper medical records, while the others used a scanned-image system, a relational database, or other methods.

But practices that have electronic health records still use paper forms for certain functions, primarily for lab orders. “Even among practices with EHRs, 30% used paper lab forms,” Mr. Gans said. In addition, 16% of the practices with EHRs used manual methods to order prescriptions and 13% used manual methods to assess drug interactions.

To illustrate one practice's experience with patient safety self-assessment, Christine A. Schon of the Dartmouth-Hitchcock Medical Center in New Hampshire shared her group's experience with the PPPSA.

The data came from the Nashua branch of the medical center and included 62 providers in five locations that serve about 250,000 patients.

The medical director of the Nashua division initiated the group's assessment as part of an ongoing goal to improve patient safety.

“We are almost paper chartless,” Ms. Schon said. “But what we want to do is make sure that we are managing our patient population effectively.”

The Dartmouth-Hitchcock group used the PPPSA as a tool to evaluate how well the group was meeting the National Patient Safety Goals. The PPPSA took about 3 hours to complete, although the time will vary according to the size of your practice, she noted.

As a result of taking the PPPSA, the Dartmouth-Hitchcock group learned that technology isn't everything.

“Our biggest 'aha' moment, as I called it, was [when we realized] that we have a tendency to rely very heavily on electronic medical records, and so we found that if we can't do it electronically, we aren't thinking about doing it,” Ms. Schon said.

“We predominantly had good electronic systems in place to make sure that we were doing safe practices and engaged with the patient,” she said.

But the group did find that, although physicians were focused on entering information into the EHR and checking for interactions, they weren't really making sure that patients understood their medications.

“That's an area where you still have to rely on a piece of paper and a conversation,” Ms. Schon noted.

Patients themselves are not always reliable if doctors ask what medications the patients are taking, she added.

As a result of the assessment process, Ms. Schon's group is considering the use of a checklist to review with patients before they leave the hospital. The sheet would explain what medications the patients are taking and why.

In addition, the group plans to stop using medication samples because they can confuse patients who take generic versions of the brands.

“We are the health care safety net for our community,” Ms. Schon said.

For more information about the PPPSA or to order PPPSA materials, visit

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