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Showing papers by "Atul A. Gawande published in 2000"


Journal ArticleDOI
TL;DR: In this paper, the authors discuss several books on the continuing discovery of the frequency and effect of medical errors, and present a survey of the literature on medical errors and their effects.
Abstract: This essay discusses several books on the continuing discovery of the frequency and effect of medical errors.

91 citations


Journal Article
TL;DR: It is demonstrated that information technologies can improve physician decision making and clinical effectiveness, but technologies demonstrated to yield beneficial effects have not yet achieved widespread adoption, though the pace of change appears to be increasing as the Internet takes hold.
Abstract: Increasing data from a few sites demonstrate that information technologies can improve physician decision making and clinical effectiveness. For example, computer-based physician order entry systems, automated laboratory alert systems, and artificial neural networks have demonstrated significant reductions in medical errors. In addition, Internet services to disseminate new knowledge and safety alerts to physicians more rationally and effectively are rapidly developing, and telemedicine to improve rural access to specialty services is undergoing substantial growth. However, even technologies demonstrated to yield beneficial effects have not yet achieved widespread adoption, though the pace of change appears to be increasing as the Internet takes hold. Scientific evaluation of many technologies is also lacking, and the dangers of some of these technologies may be underappreciated. Research on the effects of specific technologies should be a priority. Policies should be developed to press information technology companies, such as pharmaceutical and medical device manufacturers, to recognize the importance of clinical evaluation. Research could also analyze the characteristics of effective technologies and of physicians and organizations who implement these technologies effectively.

48 citations


Journal ArticleDOI
TL;DR: Major barriers still stand in the way of public access to quality information on the Internet as well as of having that access actually improve patients' care.
Abstract: Consumers are eager for information about health. However, their use of such data has been limited to date. When consumers do consider data in making health care choices, they rely more on word-of-mouth reputation than on traditional quality measures, although this information has not necessarily been readily accessible. The Internet changes the exercise of quality measurement in several ways. First, quality information—including reputation—will be more readily available. Second, consumers will increasingly use it. Third, the Internet provides a low-cost, standard platform that will make it vastly easier for providers to collect quality information and pass it on to others. However, major barriers still stand in the way of public access to quality information on the Internet as well as of having that access actually improve patients' care.

44 citations


Journal Article
TL;DR: How such technologies are being used to improve quality and performance, the future directions for advancement, and the policy and research developments required to maximize public benefit from these technologies are identified are identified.
Abstract: Investment in medical information technologies reached $15 billion in 1996. However, these technologies have not had the wide impact predicted in streamlining bureaucracy, improving communications, and raising the effectiveness of care. In this series, we identify how such technologies are being used to improve quality and performance, the future directions for advancement, and the policy and research developments required to maximize public benefit from these technologies. Each of these articles focuses on a different type of information technology: (1) information systems to manage medical transactions; (2) physician-support technologies to improve medical practice; and (3) patient-focused technologies designed to change how people manage their own care. This first article of a 3-part series examines the successes of and opportunities for using advanced information systems that track and manage medical transactions for large populations to improve performance. Examples of such systems include: HEDIS, which gathers standardized data from health plans on quality of care; the USQA Health Services Research Program, which tracks treatment patterns and outcomes for 14 million insurance members; Ford's program to collect medical data for over 600,000 employees; and Harvard Pilgrim Health Care's system of computerized laboratory, pharmacy, ambulatory, and hospital admission records for its 1.5 million members. Data from these systems have led to modest improvements in knowledge and practice patterns for some diseases. Significant barriers are slowing efforts to add outcomes data to these databases and broaden the databases to cover larger populations. Nonetheless, existing data in currently evolving systems could be used to greater benefit in tracking public health and in identifying more effective treatments and causes of diseases.

9 citations


Journal Article
TL;DR: There has been a transformation in thinking and research about medical error and injury, much of which has used information from other industries, and the single focus of both the medical profession and the medicolegal system has been on individual culpability for error.
Abstract: This essay discusses several books on the continuing discovery of the frequency and effect of medical errors.

8 citations


01 Jan 2000
TL;DR: The Internet changes the exercise of quality measure- ment in several ways as mentioned in this paper, such as: quality information will be more readily available, consumers will increasingly use it, and the Internet provides a low-cost, standard platform that will make it vastly easier for providers to collect quality information and pass it on to others.
Abstract: Consumers are eager for information about health. However, their use of such data has been limited to date. When consumers do consider data in making health care choices, they rely more on word-of-mouth reputation than on traditional quality measures, although this information has not necessarily been readily accessible. The Internet changes the exercise of quality measure- ment in several ways. First, quality information—including reputation—will be more readily available. Second, consumers will increasingly use it. Third, the Internet provides a low-cost, standard platform that will make it vastly easier for providers to collect quality information and pass it on to others. However, major barriers still stand in the way of public access to quality information on the Internet as well as of having that access actually improve patients' care.

1 citations