World Patient Safety Day: A Global Health Priority

“I will follow that system of regimen, which, according to my ability and judgment, I consider for the benefit of my patients, and abstain from whatever is deleterious and mischievous.” ?I affirmed those words, along with my medical school classmates, at Duke Medical School in 1989 when I received my M.D. degree. They are part of the Hippocratic oath, attributed to the ancient Greek physician Hippocrates memorialized in Latin as “primum non nocere” or “first, do no harm.” These words form the heart of the bioethical principle of non-maleficence, which reminds us in healthcare that it is better to not do something than to do something that will risk causing more harm than good for our patients. Yet, the medical profession has struggled with this principle throughout history.?

Consider the sad story of Ignaz Phillip Semmelweis, the Hungarian physician who used the scientific method to determine that the high death rate of mothers after giving birth in his hospital in the 19th-century could be drastically reduced by requiring health care workers in obstetrical clinics to disinfect their hands. In 1847 in the Vienna hospital where he worked the maternal mortality rate dropped from 18% to less than 2% once hand washing was instituted.? But the medical community of his day rejected his findings and were offended by him and mocked him. In 1865 he was committed to an asylum and was beaten by the guards and died.

Fast forward 150 years, To Err is Human is published by the Institute of Medicine in the United States, which documented a startling degree of medical error: “as many as 98,000 people die in any given year from medical errors in hospitals, more than those who die from motor vehicle accidents, breast cancer, or AIDS – three causes that receive far more public attention.” In the two decades since its publication, the patient safety movement has gained momentum, with some highly effective intervention developed and adopted for hospital-acquired infections and medication safety, although the impact of these interventions varies due to inconsistencies of adoption. New areas of patient risk have been identified for intervention, including outpatient care, diagnostic errors, and the use of health information technology.*

We now face new challenges with patient safety as artificial intelligence (AI) based upon machine-learning comes into the healthcare ecosystem. While the potential advantages of these new technologies is profound, there are also some serious patient safety concerns. AI systems learn from the data on which they are trained, and they can incorporate biases from the data. Some machine learning programs have been shown to “learn'' unconscious biases, leading to misallocation of medical resources based upon gender, ethnicity, or age. Due to its ability to scale decision-making, an unrecognized underlying problem in an AI system has the potential to cause injury to thousands of patients, rather than the limited number of patients harmed by any single physician’s error.

September 17 has been designated by the World Health Organization as World Patient Safety Day, based upon a resolution that “Global action on patient safety recognizes patient safety as a global health priority and endorse the establishment of World Patient Safety Day to be observed annually on this day.” At IKS Health, we take patient safety seriously. Our mission is “to provide the efficient delivery of excellent care with the vision of creating healthier consumers, happier providers and thriving organizations - ultimately leading to successful healthcare for all.” Inherent in that mission is the underlying principle of patient safety. As we develop our clinical products, whether AssuRx for prescription renewals or Scribble for clinical documentation, patient safety is part and parcel in how we design. As we add newer technologies to our clinical solutions, including those based upon artificial intelligence, we will continue to do so. Having humans in the loop remains critically important , and why the work all of us do in providing high quality products that reduce clinical burden continues to drive the patient safety movement forward.??

*?David W. Bates and Hardeep Singh, “Tho Decades Since To Err Is human: An Assessment of Progress and Emerging Priorities in Patient Safety,” Health Affairs, Vol 37, no. 11, https://doi.org/10.1377hlthaff.2018.0738 .