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Backstage at the Medical Revolution

Behind-the-scenes technologies are transforming medicine -- but who's gonna pay?

Barring Drug Errors

Everybody makes mistakes, but when mistakes come in the form of the wrong drug or the wrong dose, they can be very costly indeed. In 1994, a mistake in the dosing of a chemotherapy drug for treatment of breast cancer cost Boston Globe health reporter Betsy Lehman her life.

According to a 1999 report from the Institute of Medicine, an independent organization associated with the National Academy of Science, medication errors account for more than 7,000 deaths in the United States each year; another study estimates that "adverse drug reactions" (such as breathing failure caused by narcotics or anesthesia drugs) cause more than 100,000 patient deaths annually.

The Institute of Medicine report, titled "To Err is Human: Building a Safer Health System" says that in most cases medical errors aren't the fault of a single person or group, but instead are caused by system failures.

"[T]his is not a 'bad apple' problem," the IOM report says. "More commonly, errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent them. For example, stocking patient-care units in hospitals with certain full-strength drugs, even though they are toxic unless diluted, has resulted in deadly mistakes."

To reduce the chance of fatal or harmful drug errors, the FDA in March 2003 proposed widespread adoption of a barcode scanning system for use with all prescription drugs and select over-the-counter medications as well.

The system, which is already in use in several hospitals throughout the country, works like this:

When John Q. Patient is admitted to the hospital, he is given a bar-coded ID bracelet that links him directly to his computerized medical record. Before Nurse Nancy gives him a drug, she scans the bracelet, which calls up John's medical record, and then scans the code on the drug package. The information is whisked electronically to the hospital pharmacy, and the computer whirs into action, comparing the drug, dose, and time of administration with the prescription information already on file. If there's a discrepancy, such as the wrong drug, wrong dose, or a change in the patient's chart, the computer sends an error message to Nancy, who looks for the source of the problem.

The FDA estimates that uniform adoption of the barcode system will result in a 50% increase in the chance that a drug error will be caught before the drug is administered, leading to a drop in "adverse" drug events of more than 400,000 over the next two decades.

In addition to saving lives and preventing drug-related health problems (and the lawsuits that inevitably follow), a barcode system offers benefits that would warm the cockles of any managed-care Scrooge's heart, including greater health-care-worker efficiency, more accurate billing, inventory control, and reduced malpractice insurance premiums.

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