This is part one of MobiHealthNews’ two-part series that will highlight the evolution of innovations that changed healthcare over the past several decades.
In the past 30 years, the role of technology in healthcare has been breathtaking in its scope and impact. Thousands of technological advances, from electronic health records (EHRs) to wearables, have revolutionized medicine and healthcare.
A handful of those technologies have transformed the way doctors, nurses and pharmacists approach their work by making it more efficient and less time-consuming.
In part one, MobiHealthNews examines barcoding, EHRs and smart IV pumps.
The safety ecosystem
Robert Havasy, senior director of informatics strategy for HIMSS, told MobiHealthNews that technologies like barcode medication administration, smart IV pumps and dispensing cabinets, robotic-assisted surgery, EHRs, smart displays, wearables and AI-driven imaging have all helped reduce errors and improve real-time decision support at the bedside.
“But they’re only one layer of a much larger safety ecosystem,” Havasy told MobiHealthNews.
“Truly lasting improvements in patient safety depend on rigorous system and process design, a safety-oriented culture and human-centered workflows long before a patient arrives in a vulnerable state,” he said. “These technologies fit well as the last link in a chain of thoughtfully designed processes enacted by attentive clinicians.”
Barcodes
One of the earliest barcode medication administration (BCMA) systems was developed in 1995 at the VA Medical Center in Topeka, Kansas, and introduced nationwide in 2000.
The FDA now requires all medications to have barcodes. The aim is to help reduce the number of medication errors in hospitals and other healthcare settings by allowing care professionals to use barcode scanning to verify that the right drug, in the right dose, through the right route of administration is given to the right patient at the right time. The practice is dubbed The 5 Rights.
According to a 2018 study in the Journal of Healthcare Information Management and published in a Leapfrog Group report, BCMA is associated with reducing medication administration errors by up to 93%.
Oriana Beaudet, vice president of innovation at the American Nurses Enterprise (ANE), an umbrella organization of the American Nurses Association, says The 5 Rights are key to the medication delivery process.
“Barcodes have changed the medication delivery process especially when they are connected to the EHR. Barcodes help decrease the risk for the clinician to make a mistake, and they help assure that the care that is being delivered to an individual is accurate,” Beaudet told MobiHealthNews.
Since the introduction of barcodes into the hospital setting, their impact on patient safety has been consequential.
“Once the drug gets scanned and the nurse gives the green light, that means the drug is ready to go and the patient gets the administration,” Scott Anderson, director of member relations for the section of pharmacy informatics and technology at the American Society of Health System Pharmacists (ASHP), told MobiHealthNews.
“If the wrong thing is scanned, an alert will pop up on the screen telling the nurse this is the wrong product or the dose you scanned is twice as strong as what it needs to be,” Anderson said.
Rita Jew, president of the Institute for Safe Medication Practices, told MobiHealthNews that barcode scanning in administration has prevented many errors.
“Barcodes make it easier for people to do the right thing and difficult for people to do the wrong thing,” Jew said.
Electronic health records
It’s hard to measure the impact of electronic health records, also known as electronic medical records, on healthcare.
According to the National Institutes of Health, properly implemented EHR systems can improve healthcare quality, increase time efficiency and guideline adherence, and reduce medication errors and adverse drug events.
While EHRs seem like a relatively new technology, they have been around for a while.
ANE’s Beaudet says homegrown versions of EHRs – designed initially for paperwork workflows, not clinical workflows – existed before widespread adoption.
Although a few well-established, large-scale vendors dominate the market, there are also custom-made boutique EHR vendors.
“We are seeing a resurgence of boutique startups. There are a lot of opportunities as we move into the future with EHRs to move from data storage to analysis,” Beaudet said.
EHRs have influenced the way health system pharmacists work.
“Before EHRs were commonplace, one of the main roles of a pharmacist was to take paper orders, process them and send the drugs up to the floor,” said ASHP’s Anderson. “That was a process fraught with error – handwriting issues and dose changes that don’t get captured right away.”
Once pharmacists could process orders in the EHR, accuracy, safety and efficiency significantly improved.
“It made it where the pharmacist was not just transcribiing orders from one thing to the next, they were actually able to do more clinical review. That started the catalyst of a pharmacist being more of a clinical-minded provider,” Anderson said.
Because of EHRs, pharmacists no longer just dispense drugs; they review patient medication profiles and compare them with lab values and other data in the chart.
“It has made a big difference in the paradigm. How a pharmacist operates is completely different now because of what the EHR has been able to do for us,” Anderson said.
That paradigm shift has also benefited patients because there is now another set of clinical eyes. Before EHRs, pharmacists did not get in-depth information on patients’ medications.
Smart IV pumps
Smart IV pumps were first used in the mid-1990s but did not see widespread use in hospitals until the early 2000s.
It is estimated that 90% of hospitalized patients receive IV medications via infusion pumps.
According to Karen Giuliano, professor and co-director of the Elaine Marieb Center for Nursing and Engineering Innovation at the University of Massachusetts Amherst, smart IV pumps with built-in dose-error reduction systems have become a standard of care for addressing infusion-related medication errors for the past 20 years.
In an article authored by Giuliano and published by the Association for the Advancement of Medical Instrumentation titled, “IV Smart Pumps and Error-Prone Programming Tasks: Comparison of Four Devices,” Giuliano wrote that before the advent of IV smart pumps, programming required users to calculate the rate of infusion manually and then input the desired infusion rate into the pump.
“What makes them smart is that they have an integrated drug library,” Giuliano told MobiHealthNews. “Before smart IV pumps, you used a hand calculator to calculate the doses. There was a lot of opportunity for error there.”
For example, if one gets an order for a blood pressure medication, they can go into the drug library, find the drug and the concentration being used, pick the dosage, and the smart pump automatically calculates the rate.
“Smart pumps perform the calculations and have built-in dosing minimums and maximums for added safety,” Giuliano said.
She added that it makes a nurse’s job easier as they can choose from a list that includes all approved drugs and dosing limits.
ASHP’s Anderson said that interoperability makes smart IV pumps particularly effective.
“It is a lot harder to give a drug that is not supposed to be given because of what we are able to do now with interoperability. The data flow that the providers can see in the chart is so great. You can see when medications were actually given, when they were started and stopped,” he said.
Numerous studies, including the landmark 1999 study, To Err Is Human: Building a Safer Health System by the Institute of Medicine, revealed that hospital deaths occur in healthcare due to systemic errors.
“To Err Is Human asserts that the problem is not bad people in healthcare – it is that good people are working in bad systems that need to be made safer,” the study’s authors wrote.
The technologies above and those that will be explored in part two of MobiHealthNews’ series have transformed the way healthcare professionals perform their work and, therefore, resulted in improved patient outcomes.
Part two of our two-part series will examine the impact of automated dispensing cabinets on patient safety, how robotic surgery has made surgeons’ job easier and improved patient outcomes and their quality of life, as well as AI’s impact on the medical sector.
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