While insurance and tort reforms may be helpful, they will better promote efficiency and quality if the health care system focuses on tracking and preventing medical errors.  Many states are working toward this goal as well.

Patient Safety Databases.  It is often difficult for patients to make wise decisions regarding which doctors or hospitals to use, because they do not have comparable information about the outcome they should expect.  Many states have created patient safety databases that allow consumers to research outcomes for various hospitals and physicians.  Currently, 20 states have patient safety databases, most of which only require reporting of errors that lead to serious injury or death; reporting less serious errors is voluntary.  All but one of the 20 states have confidentiality rules barring use of the information in litigation.¹¹⁰

“Health courts with specially trained judges could expedite proceedings.”

While little data is available on the effect of such databases on malpractice lawsuit rates, a recent study examined the effect of New York’s Cardiac Surgery Reporting System (CSRS) on patient health outcomes.  Harvard University researchers examined CSRS data from 1991 to 1999 on death rates in New York hospitals that performed cardiac catheterization procedures.  They found:¹¹¹

• Moving from a low-quality to a higher-quality hospital significantly reduces a patient’s mortality risk.
• At hospitals with low mortality rates, patient admissions increased the first year following a favorable CSRS report, but dropped in the following year.
• Patient admissions at hospitals identified as having a lower quality of surgery declined by about 10 percent during the year following a poor CSRS rating, and remained at that level for three years.
• However, low-quality hospitals were still performing the same number of emergency surgeries as before the report, presumably because patients exercise little discretion in hospital selection during emergencies.

Furthermore, the study suggests that since cardiac surgery is profitable, hospitals with high mortality rates have incentives to reduce their mortality in order to attract more patients. Patient safety databases present two challenges, however.  First, health care providers must be willing to report errors.  Therefore, states must use the information for consumer education and quality improvements purposes — not for punishment.¹¹² Second, consumers must be willing to take responsibility for their health care by using readily available information.  According to a national survey by the Kaiser Family Foundation:¹¹³

• The majority of consumers (65 percent) would “very likely” obtain information on the quality of physicians, hospitals or health plans from friends and family members.
• But only 37 percent of consumers would obtain information on physician quality from the Internet.
• Furthermore, while patients are concerned about malpractice, only 2 percent consider finding a physician with a “low incidence of medical errors” to be the most important criterion in selecting a physician, although 70 percent believe reports of medical errors or mistakes tells them “a lot” about the quality of a hospital.

“Health courts with specially trained judges could expedite proceedings.”

Electronic Medical Records.  Two bills were introduced in both the U.S. House of Representatives and the Senate in 2005 that would fund the implementation of electronic medical records (EMR) for health care providers.¹¹⁴ As Robert Wachter and Kaveh Shojania note, “Moving paper from one place to another is always a dicey matter.”¹¹⁵ While neither bill has been approved, many states and localities are implementing their own reforms. For example:

• The Medicaid program in Wichita, Kansas, established a pilot program that puts about 90,000 records of patients online for local health care providers; officials expect to eventually expand the program statewide.¹¹⁶
• In Massachusetts, 450 physicians and 150 nurses are participating in a pilot EMR program funded by insurers, hospitals and the state.¹¹⁷

In addition, the U.S. Department of Health and Human Services has a program that “certifies” EMR products based on a product’s functionality, security and compatibility with other products.  So far, 19 companies’ products have been certified.¹¹⁸ Eliminating manual record-keeping is expected to reduce medical errors and improve efficiency.  Why then, aren’t EMR systems already universal?  Experts say it is because insurers don’t typically pay hospitals to install EMR systems or pay doctors to use them.¹¹⁹