Is digital health neglecting The Big Preventable–medical errors?

 

Preventable medical errors persist as the No. 3 killer in the US – third only to heart disease and cancer – claiming the lives of some 400,000 people each year.

(US Senate hearing, cited in HealthcareITNews 18 July 2014)

At the end of last month, this Editor questioned the efficacy of our current state of ‘consumer engagement’ in Patients should be less engaged, not more. The ‘less engaged’ was a call for simplification: regimens and devices which were easier to use, less complicated and far easier to fit in everyday life. (Aesthetics helps too.) Back in 2013, HeartSister/Ethical Nag (and Canadian) Carolyn Thomas called for health app (and by inference consumer engagement) designers to ‘skate to where the puck is going’–as in “For Pete’s sake, go find some Real Live Patients to talk (and listen) to first before you decide where you’re going!” Often it seems like these apps and platforms are designed in a vacuum of the entrepreneur’s making. The proof is the low uptake (Pew, Parks, IMS) and the apps’/programs’ lack of stickiness after all this time (Kvedar 8 Sep blog post).

Now Laurie Orlov tells us we were looking at the wrong puck, as analysts do. First, all that ‘nudging’ and all those apps haven’t moved the needle on diabetes and obesity. Second, why are app developers neglecting that third largest killer, preventable medical errors? Add to that 400,000 yearly–over 1,000 per day–the 10,000 estimated patients every day who suffer serious complications.

Comedienne Joan Rivers‘ cardiac and breathing arrest at an outpatient surgical center, during a minor throat procedure, led to the premature death of an otherwise healthy and dynamically active 81 year old. While it is too early to confirm, it would not be unusual if it proved to be medical or procedural error.

If you look at the Rock Health June state of digital health funding roundup [TTA 2 July], in that $2.3 billion only one company–SurgiCount, acquired by Stryker–had a primary function related to preventing a medical error, which in their case is preventing unintended foreign objects being left in the body after surgery. As Ms. Orlov put it, “Pick your way through the Rock Health portfolio — or Inc.‘s list of ‘Startups Saving Health Care’. Perhaps error prevention is hidden behind improvements in workflow? Patients not following their prescriptions? The cost of treating chronic conditions? Perhaps it is somewhere inside the opportunity for health IT. We can only hope.” (This Editor will also add the endless iterations of analytics tools.)

But wasn’t this the promise (oh, the hype!) behind EHRs? Except that EHRs aren’t decision support tools…they are documentation (and defensive) tools, and can be the source of their own errors when records don’t agree.

Medical error isn’t sexy or great cocktail (drinks) party chatter. It’s difficult in a lot of different ways, including acknowledging that hospitals, doctors, nurses and allied clinicians make mistakes because they are human. Preventing those mistakes is tough work. (And some want to leave it to megadata decision support tools like IBM Watson, which are a long way from appearing at your local hospital.) So angel, crowdfunding and VC money chases Utopia…the tech-savvy and healthy with fitness and calorie tracking (or calorie intake, like the unproven Healbe GoBe)…as well as throwing money at the latest ‘health engagement’ and ‘behavior change’ insurer and corporate programs.

Yet there the pile of gold–and good–sits on the sidewalk, in the corner, where no one notices. And developers walk right past it.

Move the Digital Health impact needle — invest in error avoidance (Boomer Health Tech Watch)

Additional reading: How Many Die From Medical Mistakes in U.S. Hospitals? (ProPublica)