IOM urges system reform to improve quality and safety

Sequel to IOM report on medical errors



IOM urges system reform to improve quality and safety

First came the tip—now the rest of iceberg is surfacing, thanks again to the Institute of Medicine. When IOM issued To Err Is Human in 1999, it said the startling conclusion that more people die each year from medical mistakes than from highway accidents, breast cancer, or AIDS was only the tip of the iceberg. The larger story was about the quality of health care.

The new report, Crossing the Quality Chasm, "discusses the rest of the iceberg," said William Richardson, chairman of IOM's committee on the quality of health care in America. "Other defects beyond safety are even more widespread," he said.

The new report says the current system does not consistently provide safe, high-quality care to all Americans. The system is poorly designed, disjointed, and inefficient. Reorganization and reform are urgently needed and should be spurred by a $1 billion "innovation fund" created by Congress to help subsidize promising projects. Calling information technology the key, the report called for automated medication order entry systems and the elimination of most handwritten clinical data within 10 years.

The report did not directly address community pharmacy issues. But NACDS said it still "should be helpful to many community pharmacy causes—such as efforts to ease restrictions on use of patient-identifiable information ... electronic prescribing, and central fill processing."

Henri Manasse, CEO of ASHP, said the report "emphasizes safety as a system property, and also that safe system design incorporates an understanding of human factors like fatigue or memory limitations." He noted that information systems "have been naively seen as the solution, when, in fact, we need to develop standards for technology and automation first.''

Michael F. Conlan


Mike Conlan. IOM urges system reform to improve quality and safety. Drug Topics 2001;6:12.