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Healthcare, Policy, Technology

Medicine ‘much more complicated’ than aviation

By Jianggan Li | 4 February 2010

Safety in civil aviation has improved dramatically over the past few decades. Substantial pressure is now on medical practices to achieve the same. While such pressure now concentrates in the United States, there have been similar calls in Asia.

However, Dr David Bates, Chief of General Medicine at Brigham and Women’s Hospital, thinks that medicine as a whole could never reach the same safety level as civil aviation.

Dr Bates is also a leading researcher in health IT; and Brigham and Women’s Hospital is one of the most sophisticated care providers in the US in terms of health IT use. The hospital belongs to Partners Healthcare System, a network of 7000 clinicians which has produced prominent figures such as Dr David Blumenthal, the current National Coordinator for Health Information Technology under the Obama administration.

“Practising medicine is just much more complicated than flying an airplane,” he explains. “Things like coronary bypass surgery are much more complicated than what a pilot would attempt in almost any circumstances. If the weather is really terrible, pilots just don’t fly; but we don’t have that luxury in medicine.”

Nevertheless, Dr Bates believes that in certain areas the safety of medicine can be brought to comparable levels as flying, and health IT would play an important part in this, such as ensuring the right medication with the right dosage is given to the right patient at the right time. The two core applications in achieving that, he believes, are computerised order entry (CPOE) and bar-coding of medication.

“Before you have COPE, doctors can just write whatever they want on a piece of paper,” Dr Bates elaborates. “I compare this to a pilot getting into the cockpit with no instrument at all.”

Brigham and Women’s Hospital implemented Computerised Order Entry at the beginning of 1995, one of the first institutions in the states to have that in place. The system has been improved over the years with additional Decision Support functionalities built in, and results are impressive: 80 per cent reduction of total medication errors and 55 per cent decrease of serious medication errors.

“Now doctors can only choose the medication that the hospital has, with a dosage which is reasonable,” Dr Bates says. “With computerisation in place, you can put in a lot of checks that you just could not do with paper.”

Commenting on the recent reports on the use of checklists, Dr Bates confirms this is another area healthcare could draw inspiration from aviation, where people have been following strict checklists to ensure safety. “There are numerous studies confirming the benefits in healthcare, and what we lack now is the embrace of that culture,” he says, adding that while introducing checklists, care providers should be cautious that overcomplicated checklists could lead to more accidents, as studies have proven in aviation.

Dr Bates hopes computerised checklists, which will be more reliable than their counterparts on paper, can be implemented in the next two to five years in healthcare.

Having studied a number of healthcare systems in Asia, Dr Bates believes there needs to be a better recognition that “the foundation for improving quality, safety and efficiency in healthcare is health information technology”, especially among the decision-making executives. He also suggests, from his own experience, that the institutions which have already substantial IT infrastructure in place should move as quickly as possible to introduce decision support, which “brings the most benefits of health IT’. And finally, he believes training of all stakeholders in healthcare to understand health IT is still an area where substantial work needs to be done in Asia.

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