The steps still to be taken in reducing medical errors

Healthcare experts call for more funding for high-tech upgrades, better training, and changes in institutional culture.

Just a C-plus. That's the grade the nation's medical system gets five years after a groundbreaking study found that as many as 98,000 deaths a year are caused by medical errors.

When the Institute of Medicine (IOM) study was released, its authors challenged the medical community to reduce medical errors by 50 percent by this year. That has not happened. Despite some improvements in awareness and regulation, preventable mishaps - like operating on the wrong leg or mistakenly giving lethal combinations of drugs - continue to be a leading cause of death in the United States.

The reason, according to a report this week in the journal Health Affairs (which gave the C-plus), is a lack of funding for high-tech upgrades and improved training. The report also cited cultural and institutional barriers that make the overall medical community resistant to change.

"It's tragic how little progress has been made, and there's no excuse for it, given the amount of waste and harm that's done by something that is clearly addressable," says Dr. Henry Simmons, president of the National Coalition on Health Care.

The American Medical Association blames fear of litigation, which it says discourages doctors and nurses from reporting errors and "near misses" that could be used to teach others. Some experts point the finger at medical educators for failing to incorporate preventive strategies in their training. Then there's the technology component. Electronic patient charts and prescription-drug databases can reduce mistakes as much as 80 percent.

But such systems are expensive, and there is little incentive for hospitals and doctor's offices to invest in them.

Many in the medical community are urging Congress to pass a bill that would set up a system for doctors and other medical personnel to report problems anonymously. It would be similar to the Air Safety Reporting System, which is credited with dramatically increasing safety in commercial aviation. It allows pilots to report potential safety problems without fear of retribution from either their airlines or the Federal Aviation Administration.

The bill already passed both the House and the Senate this year, but never made it out of conference committee. So leaders of the American Medical Association are making passage a top priority next year. "We know that confidential, voluntary reporting is the key to enhancing safety," says Donald Palmisano, former president of the American Medical Association.

Dr. Palmisano believes that passage will help ameliorate physicians' fears of being sued. A Harris poll done in 2003 found that this is the main factor discouraging doctors and other medical professionals from honestly and openly discussing problems.

The authors of the IOM report agree that medical liability is, in the words of one, "the 800-pound gorilla" in the discussion about preventing errors. But they say that liability is only one component in a larger cultural transformation that needs to take place in the medical community. The changes include simple things, like nurses reading patient names back to doctors and marking with indelible ink the site where surgery is to take place - both new requirements instituted this year by the organization that accredits hospitals.

Another proposed change is altering pay incentives. Currently, doctors receive the same reimbursement for a procedure no matter how well it's done. "Right now the payment systems don't provide strong incentives or rewards for people who do the right thing and make the right kinds of investments in patient safety," says Janet Corrigan, study director of the IOM report.

An additional key to reform is technology. Another author of the study, Lucian Leape of the Harvard School of Public Health, estimates that 80 percent of medical errors result from failures of communication. He contends that information technology (IT) is vital in changing that. Last May, President Bush named a new "czar" to head up the development of healthcare IT and set a goal of having electronic patient records be the standard in 10 years. Earlier this month, the Department of Health and Human Services awarded a new series of grants and contracts totaling $139 million dollars to develop and implement information technologies in the nation's hospitals.

Like other authors of the study, Dr. Leape is pleased that some progress has been made, but he continues to sound caution. "You have to realize what an immense challenge this is. We're trying to change a very entrenched culture in which hundreds if not thousands of behaviors have to change, and that sort of thing never goes quickly," he says. "But what we have seen in the last five years is a very definite change in the conversation."