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College gets update on efforts to eliminate errors

From the June 2000 ACP-ASIM Observer, copyright 2000 by the American College of Physicians-American Society of Internal Medicine.

By Phyllis Maguire

PHILADELPHIA—While reporting medical mistakes is necessary, a leader of the federal government's efforts to eliminate medical errors said that any system of reporting will work only if physician confidentiality is protected.

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At a joint meeting of the College's Board of Regents and Board of Governors at Annual Session, John M. Eisenberg, MACP, director of the federal Agency for Healthcare Research & Quality (AHRQ), said that a key issue in the effort to reduce errors is determining how much and what type of reporting should be required of physicians and hospitals. A big part of the problem, he said, is that reporting must meet two sometimes contradictory needs: public accountability and quality improvement.

For many physicians, reporting medical errors remains one of the most controversial aspects of improving patient safety. A big concern is that reported data might be used inappropriately. But reporting is essential, Dr. Eisenberg said, in order to learn what works and to restore public trust in light of the publicity that errors have received.

The government is launching a campaign in response to last fall's report from the Institute of Medicine on medical errors. AHRQ, a key player in that effort, expects to receive an additional $20 million next year to help establish a center for quality improvement and patient safety. The center will fund research on how to cut medical errors in half. A major thrust of the government's efforts will be to design reporting systems that can track the effectiveness of different kinds of error prevention programs.

Dr. Eisenberg acknowledged that physicians will not accept a reporting system unless confidentiality is guaranteed. He described the type of identity-protected reporting the government wants to implement as "no blame, no name, no shame." The administration has proposed—and the College supports—mandatory reporting systems, but only for those errors that result in permanent disability or death. The administration has proposed voluntary reporting of less serious errors.

The best way to preserve confidentiality of data, he said, is to encourage an adequate level of reporting. "Giving people the impression that we want to hide something just encourages those who demand going public with information," Dr. Eisenberg said. He emphasized that physicians shouldn't discount the public's concern about this issue.

He added that systems to combat errors such as standardized protocols, computerized order entry and bar-coding pharmaceuticals "will have to be built on a foundation of evidence-based medicine." With their expertise in evidence-based medicine, Dr. Eisenberg said, College members will be invaluable in helping determine what changes need to be made and how they should be implemented.

He urged physicians to exercise leadership, particularly when it comes to designing peer-reviewed protections to guard confidentiality. He said that physicians can also help HCFA develop tests to evaluate different state reporting plans. Eighteen states now have mandatory error reporting systems in place, Dr. Eisenberg reported, and their reporting requirements vary widely.

After his presentation, Dr. Eisenberg was joined by Immediate Past President Whitney W. Addington, MACP, and several College Regents and Governors. Regent Mahendr S. Kochar, FACP, said that confidentiality of data is a major concern of many physicians, particularly because of recent efforts to open the National Practitioner Data Bank to the public. But he said that the best way that physicians can work to keep that data bank from being opened to the public is to show responsibility in the current struggle to eliminate medical errors.

Steven B. Tucker, FACP, Governor of the Alaska Chapter, said that more needs to be done to assuage patients' concerns. "Patients are now afraid to enter the hospital," he said.

 

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