Health care transparency through online reporting

Can transparency in and of itself improve health care quality and process? The answer is most certainly yes if it provides a glimpse into the management and process surrounding an accident. Investigators from the Regenstrief Institute and Indiana State University School of Medicine report favorably on the feasibility of a web-based tool to track drug errors. Despite "time pressures and a culture that does not support admitting mistakes," the researchers found that their project, called MEADERS (Medication Error and Adverse Drug Event Reporting System), was adopted, accepted and used in a slew of primary health care facilities across four states, including Texas and California.

The system allowed clinicians to report medication errors confidentially. During the 10 week study period, 507 events were reported. 70% of reports were medication errors, 2% were errors and adverse drug events. In about 66% of errors the patient wasn't harmed, 11% of the time harms were documented, and nothing was reported in 20% of cases.

Errors were divided into four categories:

-Ordering medication

-Filling prescriptions

-Patient errors

-Documentation errors

Common culprits were drugs for cardiovascular conditions, pain killers, diabetes drugs, and antibiotics. Each report took about four minutes to complete. Ideally this type of data could then be used to inform quality and safety improvement processes to prevent their recurrence in the future.

The study was funded by the Agency for Healthcare Research and Quality, and published in the Annals of Internal Medicine.

This was a feasibility study to see how MEADERS would work in clinical health care settings, but it raises interesting possibilities. For examples:

What type of aps might support this type of reporting? There's already an iPhone ap called MedWatcher for reporting drug events to the FDA. But what about aps tailored to quickly, conveniently, and confidentially reporting health care mistakes to a web-based data collection site designed for quality improvement? Let doc's easily and intuitively track their own mistakes and uncover weaknesses in their delivery process.

What about public reporting of errors rates? The quest for a good metric that allows patients to separate good health care providers and facilities from bad has yet to locate the holy grail. So what about reverting to the principle of "first do no harm", and have facilities report some measure of the mistakes they make? Sure it'd create a stir in the beginning, but once we all got used to the reality that mistakes do happen in health care (as with all human endeavors), knowing something like the rate of mistakes a facility makes could be useful knowledge for the health care consumer. And perhaps the efforts at transparency and authenticity about the inevitable imperfections of those wearing the white coat would even be appreciated.

Or am I completely off base here?

Photo credit: The author, via Flickr