Medical errors and deviations from best practice are known to have a major impact on the quality and safety of patient care. Evidence published by partners in this proposal, shows that (a) over 10% of admissions to NHS acute hospitals result in adverse events, and (b) many kinds of clinical decision can be improved by a factor between 10% and 50% using decision support and other ICT services. Improving outcome and increasing safety while also reducing costs is a massive challenge facing all healthcare services worldwide (see http://www.openclinical.org/publicreportsSafetyDetails.html). It cannot be achieved by simply providing more resources, demanding that healthcare professionals work better or harder, or threats of litigation. However research strongly suggests that ICT can significantly reduce, and in some cases eradicate, many problems.
The causes of adverse events can be separated into the immediate causes, which are the result of actions, or omissions, by people at the scene. However, other factors further back in the causal chain can also play a part in the genesis of an accident. These ‘latent conditions’, as they are often termed, lay the foundations for accidents in the sense that they create the conditions in which errors and failures can occur (Reason 1997)(2). These concern issues such as poor training, problems with scheduling, conflicts between safety and profit, communication failures, inadequate procedures, failure to address known safety problems and general sloppiness of management and procedures. Human beings also have the opportunity to contribute to adverse events in the design, testing, and implementation of a new system; in healthcare however, regrettably, we do not usually consider the design of the basic systems, many of which are highly vulnerable to error.
Bates and Gawande point out that the sheer quantity of medical information, even within a single specialty, is often beyond the power of one person to comprehend. People, that is the human brain, simply cannot cope with the amount of information that they need to function safely and effectively. For instance, more than 600 drugs require adjustment of doses for multiple levels of renal dysfunction; an easy task for a computer, but one which will inevitably be performed poorly by a person1. The disparity between human capabilities and the results that it should, given our knowledge, be possible to achieve has led to the situation in which patients receive varying levels of care, with the likelihood of recovery often dependent on which medical centre the patient visits. Adverse events which seriously impact the health and even the lives of patients are all too common. The challenge is to develop the technology needed to integrate the vast pool of existing information and knowledge relevant to the care of any specific patient and deliver it in an effective and coordinated manner at the point of care.
