Similar opportunities exist for IT to help reduce errors in the human and veterinary medical professions. In human medicine, IT stores patient histories and much related data. Medical Information Systems (MIS) are in wide use in hospitals and clinics. Such systems allow problems with verbal and written communication, including misinterpretation of illegible written orders, to be obviated by efficient text-conversion software and other electronic systems. Thus, serious efforts in the appropriate use of information technology will result in less costly and more appropriate care.

Technology also helps reduce dependence on human memory for drug choices, dosages, interactions and calculations for all types of medical treatments. Errors involving medication are among the most common in human medicine; while they rarely carry significant consequence, the number that do result in adverse drug events and/or iatrogenic injuries is deemed to be greater than is socially or legally acceptable.

Recent meta-analyses found an overall incidence of 6.5 percent to 6.7 percent for serious adverse drug reactions in hospitals and determined that between 28 percent and 56 percent of these were preventable.

A recent study tested physicians' knowledge of potential drug interactions against a computer system designed to detect those interactions. The physicians fared poorly in comparison.However, several implementations of information systems are proving to reduce errors considerably, and many others have great potential but have not yet received enough study. A partial list of these interventions includes computerized physician order entries, computerized physician decision supports, robots for filling prescriptions, bar coding, automated dispensing devices and computerization of the medication administration record.

Useful technological tools

Computerized physician order entry (CPOE) is a system for physicians to prescribe pharmaceuticals online, and has probably had the biggest impact of any automated intervention in reducing medication errors.

The rate of serious errors fell 55 percent in one study, and the rate of all errors fell 83 percent in another.The benefits of CPOE are:

1. Ordering is structured so that information such as dosage, route and interval have to be included.

2. Orders are legible and the prescriber can be identified.

3. Patient information can be provided to the prescriber during ordering.

4. Orders can be checked for discrepancies such as allergies, drug inter-actions, drug-laboratory conflicts and information about the drug as it relates to a patient's liver and kidney status.

CPOE can be augmented by computerized decision support — shown to be especially important in preventing errors that actually result in injury. Such systems can synthesize and integrate patient-specific information, perform complex evaluation and present the results to clinicians in a timely fashion.

The CDSS uses a series of point-and-click steps to walk the physician through a diagnostic process while suggesting questions and bringing together data inputs from various sources.

As an adjunct to both CPOE and CDSS, some facilities have implemented a wireless alerting system that transmits real-time alerts to clinicians through alphanumeric pagers, cell phones or personal digital assistants (PDAs).

Electronic prescribing has helped reduce prescription, dispensing and administrative errors.

The use of robots to fill prescriptions has been shown to reduce errors and free pharmacists to handle more complex prescription issues requiring judgment and knowledge.

Bar coding of drugs, patients and staff will ensure that the correct drug is dispensed to the right patient at the appropriate time while logging this information into an automated medication record.

Automated dispensing devices also would be used to assure that indicated drugs are available when appropriate. PDAs and tablet computers also offer remedies for error reduction.