Health Care

Shining the spotlight on state's hospital care: Governor asks state Department of Health for a statewide sytem to report medical errors and quality

February 14, 2005

"You know more about the pizza you buy than the doctor you use," the Clarian Health Partners CEO said recently.

Evans likes talking pizza when he gives speeches about health care quality. He takes his comparison a step further when he explains how hospitals benefit by adding transparency.

"If your business is transparent, that is your customer knows you use fresh pepperoni on your pizza and the guy across the street uses frozen pepperoni, the customer's going to come to your store," he said.

The analogy helps explain why Evans is a big fan of an executive order Gov. Mitch Daniels issued last month promoting "medical error reporting and quality systems."

Daniels ordered the state Department of Health to come up with a regulation that requires every hospital to implement an error reporting system and provide data to the department, which will post it on the Internet.

Doctors, hospital leaders and watchdog groups all love the idea, they said, as long as it's implemented correctly.

The governor's directive offers basic guidelines but few details. It tells the Health Department to talk with doctors, nurses and pharmacists and to look in all corners of the health care world to devise minimum standards.

"Right now it's really far, far too soon to really get into too detailed a discussion," department spokesman Andy Zirkle said.

About 20 states have similar regulations, including Minnesota, which started posting data online last month.

The trend is not new. A 1999 report by the Washington, D.C.-based Institute of Medicine stunned many in health care when it estimated medical errors kill anywhere from 44,000 to 98,000 people in the United States each year.

Dr. Kenneth Kizer has seen studies that show medical errors trail only cancer and heart disease as the leading cause of death.

"To think that medical errors could be the third or fourth leading cause of death in the U.S., that's pretty sobering," said the president and CEO of the National Quality Forum, another Washingtonbased not-for-profit.

A way to reduce errors, advocates said, is to bring attention to them.

"I think whenever you shine the light on things and pay attention to something, it gets better," said Carol Fridlin, executive director of quality for St. Vincent Indianapolis Hospital. "We all know that."

Sharing medical error data by posting it on the Internet also speeds improvement, according to Jonathan Small of the Cambridge, Mass.-based Institute for Healthcare Improvement.

"Health care is a cottage industry. There's lots of folks that are not connected to one another," he said. "We can learn and improve a whole lot better in a collaborative way rather than independent of each other."

A guarantee of confidentiality will foster this reporting and collaboration, according to Dr. Donald Kerner, vice president and chief medical officer at St. Francis Hospital and Health Centers. People will be more open.

"The more errors we are able to discover, the more opportunities we have to put in systems and policies to prevent those errors," Kerner said.

While many in the industry agree that sharing error data is a smart move, the question of how to share it raises obstacles. Most hospitals already conduct some sort of quality measurements, said Terry Whitson, an assistant commissioner for the Health Department.

However, hospitals run different programs, and the Health Department will have to establish a standard.

"Some of them are extremely obvious like, 'Did you cut off the wrong leg?'" Fridlin said. "But others aren't so obvious."

An example is medication errors, which include prescribing penicillin to an allergic patient or providing extrastrength Tylenol when only regular strength is needed, said Dr. Bill Mohr, president of the Indiana State Medical Association.

Those two mistakes bring vastly different consequences.

"All the information needs to be put in the proper context so we don't unduly frighten or scare the public," Mohr said.

The Health Department already posts hospital consumer reports on its Web site, which provides access to data on complaints filed or deficiencies found at locations throughout the state.

Several hospital networks also formed the Indianapolis Coalition for Patient Safety in Hospitals a couple of years ago, Kerner said.

"The public needs to know we're doing a lot of things to improve quality and improve patient safety," he said. "Reporting medical errors as a mandate from the state, I think, will just move this agenda along a little more."
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