In 1999, the U.S. Institute of Medicine (IOM) reported that between 44,000 and 98,000 Americans die each year as a result of medical error, indicating more deaths due to medical errors than car accidents, breast cancer, or AIDS. That unsettling statistic was shared by Dr. Kengo Miyo from Tokyo University Hospital last weekend at AAMI 2014 in Philadelphia. He was participating in a session entitled, Hospital Information Systems from the Point of Patient Safety, which was presented by the Japanese Society of Medical Instrumentation.

Human error took center stage as the speakers discussed ways they have seen it reduced, and promising avenues to eliminate it entirely. Increasing the breadth of electronic health records (EHRs), bar coding medicine, the challenges associated with error alert systems, and political action taken by the respective countries of the speakers, were all factors taken into consideration.

An excess or deficient dose, errors in timing of administration, misreading labels, or simply failing to administer medication; these are all potentially deadly forms of error. Miyo described one case in which a woman was prescribed a muscle relaxer called Sakushizon, but went home with an anti-inflammatory called Sakushin. Wherever these mistakes originate — be it the ward where the prescription was written, in the pharmacy where it was filled, or at the bedside where the nurse administered it — there is no room for them in today's health care system.

According to research published by the Journal of the Japanese Society for Quality Control, triple and quadruple checking for errors should theoretically increase accuracy but in actuality, the potential for human error begins to rise again beyond double checking, (a possible explanation for this could be a diminished feeling of responsibility among checkers). That study would recommend the use of electronic alert systems to catch errors, but it isn't that simple. Those systems sometimes have a tendency toward false alarms, which, like the boy who cried wolf, can lead to an indifference to alarms called alert fatigue.

"For effective error prevention, a systematic approach according to the actual workflow in the hospital is required." said Miyo, "We need not only development of software functions but also innovation of hardware." By customizing alerts to the patterns within the hospital's data base, these systems can be improved upon, medication can be handled more systematically, and clinicians can better safeguard themselves against human error.

Government participation

In the U.S., registered drug vendors have been required to provide the U.S. Food and Drug Administration with a current list of all drugs commercially distributed since the Drug Listing Act was passed in 1972. In 1996, the Health Insurance Portability and Accountability Act (HIPAA) established the blueprint for access, authentication, storage, auditing, and transmittal of electronic health records (EHRs). Most recently, The Drug Quality Security Act (DQSA) of 2013 will require all non-exempt drug packages to include a 2D DataMatrix bar code on them by late 2017.

Another U.S. initiative, the Health Information Technology for Economic and Clinical Health (HITECH) Act, aims to improve quality, safety, and efficiency of health care by awarding incentive payments to eligible professionals who demonstrate meaningful use of certified EHRs. The act works in three stages to project improvements with, and adoption of, EHRs over five years.

With regards to required bar coding on drugs, Japan is ahead of the curve. A law was passed there mandating bar codes in 2006. "The Bar Code Medication Administration (BCMA) reduced the number of medication errors from 1573 cases in 2004, to 883 in 2009," said Dr. Miyo. With regard to EHRs in Japan, a research paper was issued to promote broad adoption in 2010, but no guidelines comparable to the HITECH Act have been enacted. As in the U.S., Dr. Miyo reports EHRs in Japan are more abundant in larger institutions than in smaller ones.

Another panelist, Gary W. Enos of Codonics Inc., spoke about the importance of bar coding from a business insider's perspective. His company works in medical information management, where he has witnessed first hand the effectiveness of bar codes against human error. Enos said, "44 percent of medication errors happen at the stage of selecting a prepared syringe," and the implementation of bar codes on syringes greatly reduces that number.

The potential for a safer tomorrow

By fully utilizing EHRs, hospitals can track patient data over time. They can monitor patient compliance with parameters such as vaccinations and blood pressure readings, identify who is due for preventative screening, and improve overall quality of care in practice. "EHRs [also] mean less storage expenses, less errors due to handwriting, and the creation of centralized patient information," said Dr. Masaki Takashina from Osaka University Hospital.

The full potential of EHRs is still being realized, and Takashina believes it will ultimately revolutionize the way clinicians interact with their operating rooms (ORs). EHRs can be used to schedule operations, provide perioperative records and charting, monitor anesthesia, manage supply-related finances, monitor tissue, manage surgical instruments, and monitor surgical analytics. "EHR of OR should be established carefully from a long-term point of view. We still have a long way to go to establish the EHR which meets the perioperative demand because of lack of versatile frameworks and incentives," said Takashina.

Reducing human error in hospitals goes hand-in-hand with health care innovation, and it's intrinsically entwined with the integration of new technologies and interoperable platforms. The conversation about EHRs has opened the door to a much broader concept: a fully digitized health care landscape, where computer systems not only store information but are programmed to participate actively in the practice of safe medicine. With the help of bar codes, refined alert systems, and integrated EHRs, hospitals are addressing a problem that has plagued our species for all of history: nobody's perfect.