In a recent interview with Healthcare Innovations News, foundation president, Harvey V. Fineberg, discussed a variety of important topics and issues in health care from safety to health technology to the Zika virus. Read the discussion below or access the article through Healthcare Innovation News (subscription required).
Since the Institute of Medicine’s groundbreaking book, To Err Is Human: Building a Safer Health System, in 2000, how would you rate the U.S. healthcare system in reducing avoidable medical errors?
To Err is Human helped illuminate the need to focus on safety. Since its release, the U.S. has made significant strides, including reducing hospital-acquired conditions. An Agency for Healthcare Research and Quality study found that between 2010 and 2014, there was a 17% reduction in these types of errors, including adverse drug events, pressure ulcers, falls and infections. This is a huge accomplishment translating into more than two million fewer people harmed and billions in savings. Yet many safety challenges remain. For example, diagnostic errors are getting greater national attention thanks to a 2015 National Academy of Medicine report estimating that in any given year, 5% of adults seeking outpatient care experience a diagnostic error. Increased attention is also being paid to errors that represent unintended consequences of health information technology.
Most work on patient safety to date has focused on hospital settings. We have barely scratched the surface when it comes to care provided in physician offices, clinics and patient homes. These are essential areas of focus if we are to continue to reduce avoidable medical errors, such as with medications. Nearly one in four prescriptions written in physician offices and clinics contain an error in dosing, frequency or patient instructions. Not all of these errors result in patient harm, but many do.
Overall we are making progress in hospital safety, but a tremendous amount of work remains to make all of health care as safe as it should be.
How have medical and information technologies helped clinicians provide safer and higher quality care? Which technologies and medical innovations stand out as having the most influence on decreasing medical errors?
A number of technologies have helped clinicians provide safer, higher quality care. One of the most influential examples is in the practice of anesthesiology, where the application of technology and innovation dramatically reduced medical errors – from 1 in 1,000 in the 1940s to 1 in 100,000 in the early 2000s.
The practice of anesthesia requires active engagement prior to surgery and vigilant monitoring during and after surgery. Too often things went wrong. Some describe the experience as “boredom punctuated by panic.” Progress in the field was the result of a broad-gauge systems approach. Professional associations recognized the inherent risks, raised awareness, collected data and published information about errors. Analysis of the data showed opportunities for improvement.
As a result of examining the evidence, the field expanded training for nurse anesthetists; developed new technologies, such as pulse oximetry that confirms proper oxygenation of the blood; ushered in medical equipment design changes to increase uniformity of design; and introduced fail-safe linkages that ensure the right tubes are linked to the right valves.
How has technology improved public and community health in this country?
If we consider the definition of technology as the application of knowledge for practical purposes, there are countless ways that it has advanced the practice of public health in the United States.
Water sanitation is one of the earliest and most revolutionary advances in community and public health. In the early 19th century, inadequate clean water supplies and waste disposal systems in rapidly expanding cities led to repeated outbreaks of diseases such as cholera, typhoid and tuberculosis. Collective efforts at the local, state and federal levels helped to improve U.S. waste disposal, water treatment and other sanitation leading to overall health improvement and reduction in mortality.
We have also seen sweeping public health benefits with the elimination of smallpox and prevention of many other infections through vaccines; the ability to cure bacterial infections with the use of antibiotics, such as penicillin; and drastic reduction in infant mortality through better prenatal care and nutrition.
Today, epidemiological studies have illuminated the health burden of tobacco use, poor diet, lack of physical activity and gun violence. This knowledge is fueling new public health innovations focused on incentivizing behavior change.
In turn, that knowledge is informing the creation of consumer technologies supporting healthy behaviors. Examples include online forums that provide support for people who want to quit smoking, apps that simplify calorie counting, wearable devices that track physical activity and the use of fingerprint technologies that prevent guns from firing in the hands of kids or other unauthorized users.
In evaluating vaccines and their use, how do you allay the fears of many parents who believe there is a causal association between immunizations and several conditions, including autism?
The simple answer here is “with great difficulty.”
The evidence on the safety and benefits of vaccines is clear. Unfortunately, anecdotes about the onset of autism coinciding with the timing of immunizations fuels myths and fears. Add to that the relative rarity of diseases like measles, mumps and pertussis, and it can be easy to understand why a parent might choose to opt out. The recent outbreaks of childhood diseases that we believed we had controlled are important reminders that herd immunity is fragile. As a society, we have an obligation to others.
Public policy is an important tool for addressing this challenge. We can narrow the grounds for which parents can opt out of immunizing their children. We may also want to take a different approach to “informed consent.” Right now, parents sign consent forms verifying they understand the risks and benefits of the vaccines being administered. Bill Foege, an epidemiologist and one of the modern heroes of public health, suggests flipping the approach: Ask parents who opt out to sign informed non-consent, acknowledging that they are willingly putting their child and others in their community at risk.
As Zika raises its head in the United States, are there processes our healthcare system has learned in addressing similar viruses? What decisions must be made in quelling what could become a larger problem?
We know how the disease is transmitted and some means to protect against that risk. It can be a challenging problem though some efforts, including mosquito abatement, public awareness, bug spray and condoms, can make a real difference. Local and state governments need access to funding that will enable them to take the necessary steps to protect their communities.
We also need to invest in scientific research to better understand the disease. That knowledge can inform the development of vaccines and, hopefully, lead to treatments that will prevent the birth defects caused by Zika. The failure to date of the U.S. Congress to pass funding is putting politics above the public interest.
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