Improving Safety with Information Technology.

ealth care is growing increasingly complex, and most clinical research focuses on new approaches to diagnosis and treatment.In contrast, relatively little effort has been targeted at the perfection of operational systems, which are partly responsible for the well-documented problems with medical safety. 1 If medicine is to achieve major gains in quality, it must be transformed, and information technology will play a key part, 2 especially with respect to safety.In other industries, information technology has made possible what has been called "mass customization" -the efficient and reliable production of goods and services according to the highly personalized needs of individual customers. 2Computer retailers, for example, now use their Web sites to allow people to purchase computers built to their exact specifications, which can be shipped within two days.Medical care is, of course, orders of magnitude more complex than selling personal computers, and clinicians have always strived to provide carefully individualized care.However, safe care now requires a degree of individualization that is becoming unimaginable without computerized decision support.For example, computer systems can instantaneously identify interactions among a patient's medications.Even today, more than 600 drugs require adjustment of doses for multiple levels of renal dysfunction, a task that is poorly performed by human prescribers without assistance but can be done accurately by computers. 3][5][6] In the past decade, the risk of harm caused by medical care has received increasing scrutiny. 1The growing sophistication of computers and software should allow information technology to play a vital part in reducing that risk -by streamlining care, catching and correcting errors, assisting with decisions, and providing feedback on performance.Given the large potential risks and benefits as well as the costs involved, in this article we analyze what is known about the role and effect of information technology with respect to safety and consider the implications for medical care, research, and policy.Information technology can reduce the rate of errors in three ways: by preventing errors and adverse events, by facilitating a more rapid response after an adverse event has occurred, and by tracking and providing feedback about adverse events.][9][10][11][12][13][14][15][16][17][18] The main classes of strategies for preventing errors and adverse events include tools that can improve communication, make knowledge more readily accessible, require key pieces of information (such as the dose of a drug), assist with calculations, perform checks in real time, assist with monitoring, and provide decision support.h ways that information technology can reduce errors