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The Life and Death Results of Information Quality

Published: November 8, 2006

Poor information and the inability to make medical decisions with correct, complete and timely information may kill more people than any single disease in the United States.

After spending much of my career in healthcare, I became increasingly aware of the problems that plague our nation today.  This plague is not a virus or bacteria, but rather information that we use every day!  We have new diseases that pop up every now and then and stir many into chaos.   We were all very frightened about the hantavirus that killed almost everyone it came in contact with in 1993.  More recently, we were looking at the deadly Avian Influenza A virus, known as the “Bird Flu,” as it approached the boarders of the United States.  These all draw our attention to the possibility of it happening to us, while we overlook a great disease that is already plaguing us – poor information quality. 

Images of people laying in hospital beds gasping for air or people being carried off in body bags certainly get our attention, but in reality, these diseases only reach a fraction of a percent of the population.  For example, as of February of 2006, the hantavirus had infected 416 people in the Untied States taking the lives of 149 people, while the Bird Flu has killed 91 of its 169 victims.  Compare this number to those patients that die as a result of medical errors each year. 

In the 1999 report from the Institute of Medicine (IOM), it was reported that as many as 98,000 people in the United States die each year as a result of medical errors.  In July of 2006, they released another report stating that 1.5 million Americans are injured every year through mistakes in medication errors (Institute of Medicine, “Preventing Medication Errors,” 2006, p. 3).  The Agency for Healthcare Research and Quality (AHRQ) states, “Most people believe that medical errors usually involve drugs”; however, they explain, “there are many other types of medical errors” such as diagnostic errors, equipment failure, infections, blood transfusion-related injuries and misinterpretation of other medical orders.  The question that must be asked, therefore, is how many of these errors are related to poor information quality?

I believe poor information and the inability to make medical decisions with correct, complete and timely information kills more people than any single disease in the United States.  In the same way we have tagged diabetes with the term “the silent killer,” poor information quality creeps into our decision-making capabilities like a thief in the night.  When patients die because their blood glucose levels get too high after surgery, we say, “We didn’t know they were diabetic.”  When lab results come back negative for cancer, we are happy to go on our way only to find out months later that the disease spread and the patients are now terminal. We then say, “We got faulty lab results.”  When the wrong blood type is given to patients and they die, we say “What an unfortunate mistake.”   We look to blame the person that made the mistake.  We sue our doctors and nurses, which contributes to the rise in healthcare costs and malpractice insurance, while ignoring the processes that lead to the poor information that causes the problems to begin with.  All this, while still unable to turn back days and reverse the fact that terrible mistakes have separated you from your loved ones.  

Poor information quality and the processes that lead to it unlock large ethical questions in healthcare that will need to be addressed.  Since we all are customers of the healthcare service industry in one way or another, we owe it to ourselves to ensure that the problems that plague it are solved.  The startling realization, according to the Institute of Medicine, is that every patient is subject to one administration error per day (Institute of Medicine, “Preventing Medication Errors,” 2006).  These errors are not selective.  Every person that entrusts their care to medical professionals throughout the United States is entered into this pool of risk.  If you have been fortunate enough to avoid the need to entrust your care to someone else, you can consider yourself in the minority.  You, however, are not free from this inevitable need in the future. 

A common misconception related to information quality is the practice of employing data systems to “solve the problems.”  The IOM 2006 report states that “Paper-based prescribing is associated with high error rates” and “electronic prescribing is safer” (Institute of Medicine, “Preventing Medication Errors”, 2006, p. 10).   Although this is true, some have taken this to mean that the move to electronic prescribing will eliminate the problem. This was alluded to when, in response to the IOM 2006 report, the New York Times reported that “Just 3 percent of hospitals have electronic patient records” and healthcare organizations should increase “the use of information technology to reduce medication errors.”   In another response to the IOM article, one healthcare organization reported “The pharmacy’s director says the robot eliminates mistakes that humans make.”  

An anonymous witness from another healthcare organization, also using the “robot” and electronic medical records, experienced a medication error that resulted in a patient’s death.  The mistake came from the pharmacy and the wrong medication was ordered.  The nurse prescribed the medication just as the electronic medical record directed.  She did not understand what the medication was, its indications, or purpose for giving it.  When asked why she administered the drug, she responded, “It is not my fault, your little machine told me to give it.”  In this example, all of the electronic devices were employed, but an electric tool replaced personal responsibility and accountability.  The facade that electronic systems eliminate error apparently gave the caregiver the thought that she could neglect her requirement to administer it safely.

Every industry in the world depends on information. The quality of that information is what determines those that succeed and those that fail. For example, getting the right information on time can make you rich, but that same information presented incorrectly can drive you to bankruptcy.  Many organizations have seen the need and opportunities to manage their information well.  Manufacturing companies have applied quality principles to their information much like they do to their production lines.  They have streamlined the use of information by building quality processes throughout the value chain as opposed to repairing the defects at the end.  Through these efforts, they have been able to save countless dollars and drive successes far above their competitors.  Although healthcare organizations can share in these same financial opportunities, their cost of doing nothing has much greater consequences – consequences of life and death. 

The quality principles pioneered by legacies such as W. Edwards Deming and Philip Crosby have been extended into the information age by people such as Larry English, David Loshin and Thomas Redman.  For healthcare to overcome the detrimental effects produced by information quality problems related to medication errors and inappropriate care, it must begin to implement information quality principles. 

Although the task of implementing an information quality program may appear to be insurmountable, responding to the aftermath resulting from ignoring it will be far greater.  Awareness and exposure of the lack of information management by healthcare organizations through reports from places like the Institute of Medicine will plague the community.  Healthcare professionals will be forced to respond and will be held to a higher level of accountability when patients entrust them with their care.  The choice is not “if” to act, but “when.”  Surviving organizations will be those that are proactive and prepare themselves for a future of quality information which will lead them to the highest level of quality care.

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