This article uses excerpts from "Just-in-Time Delivery Comes to Knowledge Management," published by the Harvard Business Review (Vol. 80, No. 7, July 2002).
Ten years ago, researchers at two Harvard Schools found that the number of medical errors was extremely high at Partners Healthcare hospitals, also based in Boston.
After looking at these alarming numbers, Partners Healthcare decided to start a project linking "massive amounts of constantly updated clinical knowledge to the IT systems that supported doctors' work processes."
Let's look at how the system currently works.
Let's say Dr. Bob Goldszer, associate chief medical officer and head of the Special Services Department at Brigham and Women's in Boston, has a patient, Mrs. Johnson, and she has a serious infection. He decides to treat the infection with ampicillin. As he logs on to the computer to order the drug, the system automatically checks her medical records for allergic reactions to any medications. She's never taken that particular medication, but she once had an allergic reaction to penicillin, a drug chemically similar to ampicillin. The computer brings that reaction to Goldszer's attention and asks if he wants to continue with the order. He asks the system what the allergic reaction was. It could have been something relatively minor, like a rash, or major, like going into shock. Mrs. Johnson's reaction was a rash. Goldszer decides to override the computer's recommendation and prescribe the original medication, judging that the positive benefit from the prescription outweighs the negative effects of a relatively minor and treatable rash. The system lets him do that, but it requires him to give a reason for overriding its recommendation.
Even if the project started a decade ago, it's still far from completed. Nevertheless, it achieved pretty interesting results.
The on-line order-entry system and related knowledge are only accessible within the organization's two flagship hospitals, Mass General and Brigham and Women's. Medical knowledge has not yet been codified for all the diseases that Partners physicians treat. But the approach is clearly beneficial. A controlled study of the system's impact on medication errors found that serious errors were reduced by 55 percent.
And I saved the best for the end.
These improvements not only save lives, they also save money. For starters, the system now recommends cheaper as well as more effective drugs.
Source: Thomas H. Davenport and John Glaser, HBSWK Publication, Aug 12, 2002
5:57:54 PM
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