Many of us have experienced a situation in a healthcare facility where we are asked the same questions during our encounter. Questions about medications taken at home, insurance coverage, or reason for the visit seem to arise with every department in the hospital we visit. As an integrator I always question why this redundancy is occurring. My hypothesis is that the causal factor is a result of the lack of interoperability due to missing integration between disparate and even same vendor systems. This is an overlooked but vital component of the holistic healthcare enterprise.
Home medication reconciliation and inpatient/outpatient medication administration is a prime example of where improvements can be recognized. Statistics show that there are 5 errors for every 100 orders and 1.4 medication errors per hospital admission. Consider that 7,000 patients die each year in the U.S. as a result of medication errors adding about $2 billion a year in cost to the facilities. According to a study by the Institute of Medicine (IOM) each preventable medication error adds at least $8,750 to the cost of a hospital stay. Medication errors are one of the most common causes of preventable harm a patient can experience. In 1999 the IOM reported that 98,000 people die every year from preventable medical errors which cost about $29 billion dollars. A University of Toronto study found that pharmaceuticals kill more people in the U.S. than motor vehicle accidents and that, of the 2 million hospitalized Americans who suffer from serious adverse reactions, about 100,000 died from their reaction and, of those deaths, about 75% were not due to allergic reactions but were preventable.
Facilities willing to hold vendors accountable and perform the needed work to integrate ED, OR, inpatient, and outpatient medication administration, order entry, and documentation can prevent these errors. Computerized Physician Order Entry and Clinical Decision Support Systems are great examples of systems used to decrease the number of errors at the order entry phase. However these systems often lack complete communication with all systems in the enterprise, leaving the possibility for missed alerts to physicians for medication allergies and drug interactions.
Systems integration and compliance are vital in achieving a safe medication use process. Hospitals that have extensive computerized technology and have greater automation tend to have lower costs. The key to deploying a fully integrated system is understanding what data elements are pertinent and allowing them to flow across the enterprise. In the healthcare software industry today integration is not just needed it is required to ensure we get the longitudinal view of the visit as well as the life of the patient.