UC System to Track Medical Errors

Times Staff Writer

The University of California announced Thursday it will launch a new Internet-based system to track medical errors at its five campus medical centers, joining other major health care providers in computerizing medical records to improve quality and efficiency.

The Internet-based system, which has been developed by the university, will allow hospitals to track trends in medication errors, adverse drug reactions, blood transfusion errors, patient falls and bed sores.

The University of California also will establish a “harm score system” for evaluating each error and comparing it with others.

Nationally, major medical systems such as that of the Department of Veterans Affairs have been leaders in systematic efforts to reduce errors using technology.


In February, Kaiser Permanente, the state’s largest HMO, rolled out a $1.8-billion plan to give doctors and patients access to medical histories, test results, prescription information and other data, in part to reduce errors.

The problem of medical errors has received increasing attention after the publication of a landmark report from the Institute of Medicine in 1999 which estimated that between 48,000 to 98,000 fatal medical errors occur annually in the nation’s hospitals.

Most common are medication mistakes, such as administering the wrong drug or the wrong dosage, perhaps at the wrong time.

Though other medical systems have developed error reporting systems of varying sophistication, university officials say the University of California project is the first in the nation to link academic medical centers on a systemwide basis through the Internet.


The system will not be accessible to patients.

However, patients may make suggestions and notify medical authorities if they experience or witness medical error or “near misses,” said Dr. Lee Hilborne, director of the UCLA Center for Patient Safety and Quality.

“What I’m really excited about is, hopefully, we’re going to be seeing more reporting” of these mishaps, Hilborne said. Hilborne is also director of a program called the Strategic Alliance for Error Reduction in California Healthcare.

The system will permit medical personnel to report errors anonymously, though they are urged to do so by name.


“What we’re trying to do, particularly at UCLA, is to really reward people for coming forward,” Hilborne said.

“Frankly, if punishing worked, we wouldn’t see the kinds of errors we see today,” he said.

“But also, we’re trying to create a culture -- switching from naming, blaming and shaming to one that says, ‘How did this happen? The purpose is to prevent it from happening in the future.’ ”