Goal of Standardized Care is to Reduce Medical Mistakes

According to an article in the National Journal Online, the local medical behemoth/monopoly, Intermountain Healthcare (IHC), has stumbled onto a concept that can help reduce infant mortality rates. The American College of Gynecologists and Obstetricians (ACOG) issued a statement to physicians indicating that births should not be induced before a fetus reaches 39 weeks. IHC was one medical provider that heeded the suggestion and then it reviewed its electronic medical records to determine if it could identify a drop in the number of newborns sent to the ICU or who died. IHC estimates that for the review period, between 400 and 500 newborns were not sent to the ICU and, accordingly, IHC adopted a system-wide policy to not induce births before 39 weeks.

IHC says that the lesson to be learned here is that routines and consistency are very important in delivering quality and effective medical care:

"It’s our belief that most of the problems that happen in health care are not because the right thing isn’t known, but because the right thing isn’t done consistently," said Greg Poulsen, senior vice president of Intermountain.

Administrators at these hospitals preach "evidence-based medicine," where the best practices are analyzed, identified and then made the norm. Standardizing care, they say, can reduce mistakes that keep patients in the hospital longer than needed. "Last I heard, no pilot intentionally landed with the wheels up, but that used to happen all the time before they had checklists and automated routines," Poulsen said. "What we’ve discovered is the thing that was most likely to keep people alive was being very routine in care."

Now the concept has developed to the point that it is being included in the various health care reform plans circulating through Congress. The idea is that the secretary of Health and Human Services (HHS) will be required to set up standards for electronic records systems that medical providers will have to utilize under the threat of a financial penalty or decreased funding.

David Blumenthal, a representative of HHS, has indicated that ease of use will be key for physicians and that cost concerns need to be addressed:

Administrators at these hospitals all warned that legislation can be designed to encourage electronic records, but the system has to be one doctors will actually use. David Blumenthal, national coordinator for health IT at the Department of Health and Human Services, is being tasked with overseeing the switch to electronic records and certifying new records systems. Blumenthal said that one basic capability he was looking for was computerized order entry, a system to centralize doctor recommendations for the next step in care, from a drug prescription to referrals to a specialist.

"Basically, if you want to do anything to a patient, you have to find that patient’s record on the computer and launch a program that prompts you to type in the order," Blumenthal explained. The computer could then alert you to a generic drug option, any negative drug interactions, allergies or other complications. He also said the better systems would have pre-formed sets of recommendations to eliminate oversights.

Blumenthal said he expected health IT systems will soon be the standard in hospitals, despite the fact that only 13 percent of doctors currently use even a basic electronic system, according to a survey in the New England Journal of Medicine. (Four percent report having a full e-records system.) Doctors’ slow adoption is largely a factor of cost concerns and a lack of financial incentives. The health care bills would offer bonuses to providers using an electronic system and even some penalties for not using one.

Finally, Blumenthal noted that uniformity across the country will be critical to the success of a comprehensive electronic records system:

Another concern was that the system had to be uniform across the country so that data could be shared with hospitals across city or state lines. Blumenthal said he was enlisting states in that regard and that his team was working on the Nationwide Health Information Network, which would be a secure "network of networks" for sharing health information across the country.

So while IHC can be criticized for many things, many things, given the nature of its domination of the health care market in Utah and southeastern Idaho, it should be praised for embracing the notion of standardized health care. Let’s hope that any health care reform that passes embraces it as well.