P1: GMW Aspen Pub./JACM As101-07 November 17, 2001 12:52 Char Count= 0 Quality, Patient Safety, and Medical Errors: Resistance to and Support for the Federal Recommendations to Address These Concerns Terry L. Wahls, MD, FACP Kanan Chatterjee, MD Henry Ting, MD, FACC Timothy J. Clancy, BS, MS, PE The Institute of Medicine’s report To Err Is Human was a catalyst for concern regarding quality, patient safety, and medical errors. The most effective actions will occur in the federal health care system. Revision of research agendas, accreditation, and education standards will also be successful. Reg- ulatory changes and legislative initiatives will come about more slowly. The application of information technology will be slowed by costs and lack of infrastructure and of standards. Reporting systems will be resisted. Changes will continue incrementally until the cost of enabling information technology falls and medical groups compete on the basis of quality. Key words: health care policy, medical errors, medical informatics, patient safety, quality T HE INSTITUTE of Medicine (IOM) re- port To Err Is Human: Building a Safe Health System (Institute of Medicine, 1999; Leape, 1994) estimated that 98,000 people die annually in America as a result of pre- ventable medical errors, at a cost of $29 bil- lion. The report cited a wide body of research supporting its finding that the main prob- lem is systemic rather than poor individual performance. The troublesome statistics of avoidable deaths and excess costs focused public and political attention on these issues. This article details the governmental recom- mendations in response to the IOM report, discusses problems with and opposition to these recommendations, and concludes with the probable outcomes in the near future. GOVERNMENTAL ROLE IN HEALTH CARE Discussion of the governmental responses to the IOM report should begin with a review of the roles the U.S. government currently plays in health care delivery. These roles in- clude • providing health care (e.g., the Veter- ans Health Administration [VHA] and Indian Health Service) • purchasing health care (most notably through Medicare and Medicaid) • regulating health care (through agen- cies like the Food and Drug Admin- istration [FDA], Occupational Safety and Health Administration, as well as Terry L. Wahls, MD, FACP, Associate Professor, Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa Kanan Chatterjee, MD, Associate Medical Director, Department of Cardiology, Mayo Clinic, Rochester, Minnesota Henry Ting, MD, FACC, Staff Physician, Health Partners HMO, Bloomington, Minnesota Timothy J. Clancy, BS, MS, PE, Administrator, St. Luke’s Hospital, Duluth, Minnesota J Ambulatory Care Manage 2002, 25(1), 54–62 c  2002 Aspen Publishers, Inc. 54