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Medical errors and decisioning

Interesting article on USA Today Report finds drug errors injure more than 1.5 million. The article estimated more than $3.5B in unecessary costs. It gave a list of things you can do as a consumer to help. It made me think of things you can do if you are part of the healthcare system to make it work better. For each recommendation made to consumers I have tried to make recommendations to those working in healthcare - wise and effective use of decisioning technology can address some of these issues.

  • Maintain a list of prescription and nonprescription drugs, vitamins and other dietary supplements you use. Take that list with you whenever you visit a health care provider.
    • Healthcare providers could use the web and other channels to make it easier for consumers to provide this information directly using smart forms, for instance, to collect the right data efficiently
    • Obviously an electronic medical record would help but only if it is actually used
  • Ask your doctor to write down the drug's name, dose and how to take it. At the pharmacy, make sure those instructions match what's on the bottle you're given.
    • Electronic prescriptions help with this a lot
  • You can ask both the doctor and pharmacist about side effects and how to use the drug.
    • Using a rules-based approach to manage side effect description allows medical staff to manage the rules, makes it easy to change as soon as something new comes out or new information emerges
    • Automation of this check means that potential side effects can be highlighted when it is prescribed, when it is filled and, potentially, when the patient uses an online medication management system
  • Pharmacies often maintain computer records that can flag drugs that will interact dangerously, if you fill all your prescriptions at the same chain
    • At least one of these is a Fair Isaac customer using business rules to do exactly this
    • Some forward-thinking hospitals, like Parkview Health, are also doing this at a hospital level
  • If your pills look different when they're refilled, don't assume the maker changed the size or color - ask the pharmacist why. You could have been given the wrong drug or dose.
    • Use rules to generate "scripts" for nurses administering and patients taking drugs that say things like "take 2 of the small blue pills" to help double check
    • Use rules so that you can easily change them when a maker does, in fact, change it
  • At the hospital, ask the doctor and nurse what drugs you're being given, why and what effects to expect.
    • See above
  • Before surgery, ask if there are any medicines you should avoid or stop taking beforehand.
    • Integration of rules-based alerting across drugs and procedures is something hosptials should be managing
    • Admission rules for surgeries should, for instance, trigger checks against drugs being taken so that admitting staff can confirm the patient has already stopped the medication to avoid admitting someone who can't be operated on anyway
  • Prior to hospital discharge, ask for a list of medications you should be taking at home and how to take them.
    • A good hospital management system should be able to apply the discharge rules and post-discharge care rules and generate instructions and advice for consumers

Beyond all this rules-based checking there is growing interest in using predictive analytics to identify patients in specific segments or who should have specific treatment. Forward-looking providers should be checking into that too. One thing to note - it's not as easy as all that to inject rules into medical processes - two many alerts and doctors and nurses start to get "alert fatique". Check out this white paper by Mark Clare and Mark Pierce at Parkview Health.

Today is turning into a healthcare day...

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