Patient safety is receiving growing attention in healthcare with a focus on reducing or eliminating adverse events that can be prevented. Further, at a time when healthcare spending is being cut and funding is scarce, services are required to provide safe and reliable care with decreasing resources. The human and economic cost of preventable adverse events is multiple times the cost of ensuring good quality information is available at all times in care provision:
The World Health organisation (WHO) reported that in the National Health Service (NHS) in the UK, the cost of extra bed days resulting from these adverse events is estimated at more than £1 billion GBP per year in the acute care sector alone. A study recording surgical adverse events in the UK found that of 24,185 surgical admissions, there were 461 adverse events reported. 54% of these events were due to administrative and communication problems with health information. The human cost of these types of errors in terms of loss of independence and productivity is immeasurable. The WHO describe the tragic example of Caroline to highlight the absolute need for access to good quality health information. Caroline was a new mother who suffered from a post epidural abscess which led to meningeal septicaemia and ultimately, her untimely death. It was found that at many times during her care, there was a notable lack of availability of her health information and her medical records were lost on a number of occasions. This led to misinformed mistakes being made that resulted in her death.(1)
So how do we improve the safety of our services while achieving greater efficiency?
Safe and reliable healthcare depends on clinicians having access to high quality data and information that is correct, concise and accessible where and when it is needed. Moving from the use of paper based health records to electronic records provides a key opportunity to improve upon patient safety while also achieving significant efficiencies and cost savings. Here’s how:
Readability and accuracy
Paper records are often difficult to read, can become damaged over time and the risk of misinterpretation of handwriting or the meaning of what is written is very high. Clinicians writing notes while busy are more likely to shorten text and use abbreviations. Abbreviations often mean different things across different specialties in healthcare and misinterpretation can result in death in the worst case scenario. Electronic records allow healthcare notes to be documented in a universally readable typeface, reducing the potential for illegibility and misinterpretation. Also, electronic records can adopt standard clinical terminologies such as SNOMED CT(2)
, which ensures that the meaning of health information remains the same across different specialties and services, drastically reducing the potential for confusion. Warning systems can be added to help reduce the risk of prescribing the wrong drug or dangerous doses of medication and reminders can be established to ensure treatments and appointments are not missed. Efficiencies can be gained as electronic systems can help to ensure that relevant, high quality information is captured in a timely manner at the point of care.
Locating and sharing paper health records can be difficult and time consuming. Files are misplaced or lost and in order to share a paper health record, it must be moved in its entirety or physically copied. Both methods of sharing are time consuming, resource intensive and can result in the loss of the record. Electronic health records can be accessed when and where they are needed by authorised persons. Timely access to health information can save lives when allergies, current medications and up to date diagnoses are accessible at the point of care.
The storage of paper health records represents a large cost to service providers. As health information is sensitive, health records must be stored securely. This results in large, secured health record libraries with many staff resources needed to manage and maintain health records and also access to those records. Movement of any record into or out of a health record library must be tracked in order to ensure the record is protected both physically from the risk of loss and also in terms of data protection. The storage of electronic health records can be achieved more securely and using much fewer resources.
In general, a paper health record exists as a single non repeating entity. This means that if it is lost, it is unlikely that the health information within the health record can ever be recovered. The risk of this occurring is significant as health information is required for the duration of patient care and attendances and also for research purposes. There is also a high risk of unauthorised access to paper health records or part thereof as records are often carted to various locations within hospitals or clinics with minimal supervision. Electronic health records can be stored securely and while there is a risk of unauthorised access, this can be minimised through use of role based access controls and robust authentication processes.
While there is an initial upfront cost associated with adopting an electronic approach to health information, these costs are rapidly surpassed by the savings accrued from a reduction in resources required to manage health records. Significant cost benefits are also realised by the efficiencies gained through accessibility to health information when and where it is needed at the point of care and also through faster record and episode creation, maintenance and management.
The gathering of meaningful data from large cohorts of people is extremely difficult in a paper based environment. Manual identification of relevant health records to any particular research requires a huge human resource and time effort. Electronic records can be searchable by data element, allowing for fast access to large amounts of anonymised data. This vastly increases the capabilities of researchers to carry out large scale or longitudinal studies, thus resulting in higher quality research results.
The improvements that can be achieved by adopting electronic health records combine to significantly increase patient safety when accessing healthcare services. Change is difficult, but making the transition to reduce or eradicate paper records benefits the health and safety of all individuals accessing healthcare services and serves to significantly reduce costs, improve communication and sharing of health information and minimise resources required into the bargain.
Clare Harney Quality Manager at Sláinte Healthcare
A native of Dublin, Clare joined Sláinte Healthcare in 2014 in the new role of Quality Manager. Her previous roles include Health Information Project Manager for HIQA researching and developing health information standards, guidance and recommendations. She was also seconded to the Department of Health in 2013 as an advisor to aid the development of legislation for the introduction of health identifiers in Ireland. Prior to this, she gained experience working for many years in both the public and private health sectors. Her current responsibilities include managing quality and risk management processes and procedures across Sláinte Healthcare.
(1) www.who.int/patientsafety/education/curriculum/who_mc_topic-1.pdf / www.bmj.com/content/322/7285/517
(2) SNOMED Clinical Terms (SNOMED CT) is the most comprehensive, multilingual clinical healthcare terminology in the world. http://ihtsdo.org/snomed-ct/