Advancing the Use of Health Information Technology To Reduce Medication Errors and Improve Patient Safety
By continually testing assumptions about how, where, and why medication errors occur, David W. Bates, M.D., M.Sc., Chief of the Division of General Internal Medicine and Primary Care at Brigham and Women's Hospital, has created a strong foundation of evidence and practical guidance that helps hospitals and clinicians improve medication safety and reduce risks to patients.
Questioning the conventional wisdom of the early 1990s about the origins of medication errors, Dr. Bates was among the first to find that a significant portion of medication errors in hospitals occurred at the time when physicians placed the drug order, not when they were dispensed or administered. Over the course of more than 20 years, he has used AHRQ funding to identify solutions to medication-related risks to patient safety. Many of Dr. Bates' AHRQ-funded studies identify how health information technology (IT) can improve the safety and quality of care through better use of computerized physician order entry (CPOE), smart infusion pumps, clinical decision support, and electronic health records (EHRs).
For example, Dr. Bates' 2001 AHRQ-funded study of smart infusion pumps was among the first to show that the combination of technology, decision support software, and human factors could contribute to medication errors and preventable adverse drug events (ADEs). In some cases, nurses bypassed drug libraries and administered drugs without first getting orders documented by the physician. Insights from that AHRQ-funded project led to his widely quoted article, Ten Commandments for Effective Clinical Decision Support, which ranked the speed of the information systems as clinicians' top priority.
AHRQ funded Dr. Bates in 2005 to quantify physician adoption rates of EHRs and learn more about which barriers persisted and why. Start-up financial costs played a big role in physician reluctance, as did concerns about loss of productivity. Even among practices that had adopted EHRs, only a small number consistently used key features such as clinical decision support. His findings shed light on the areas where policies or practices could be changed to support physician adoption and integration of EHRs to their full potential.
In a current AHRQ-funded study, his research team is modernizing a "flight simulator" for EHRs with CPOE that was created in collaboration with the Leapfrog Group, a national health purchasing watchdog. The simulator allows physicians to download high-risk scenarios and practice using CPOE within the actual EHR to practice treating simulated patients in a virtual—and safe—environment. The project, set to conclude in 2019, will determine how well hospitals are performing on the test and show whether they are improving over time.
Dr. Bates has received numerous honors and awards, including the John M. Eisenberg Award for Excellence in Patient Safety Research and the John M. Eisenberg National Award for Career Achievement in Research. Both awards were named in honor of the late AHRQ Director who led the Agency from 1997 to 2002.
Principal Investigator: David W. Bates, M.D., M.Sc., Senior Vice President and Chief Innovation Officer; Professor of Medicine, Harvard Medical School.
Institution: Brigham and Women's Hospital
Grantee Since: 2001
Type of Grant: Various