Education: Stanford, BS (1979); Johns Hopkins, MD (1983); Harvard School of Public Health, MPH in Health Policy and Management (1988)
How I describe my work to those outside the field …
I work on using computers to improve the quality, safety and efficiency of medical care and a particular focus has been on improving medication safety.
Years of experience
I started my work in informatics about 25 years ago. Reed Gardner was the one who really encouraged me to get involved with AMIA—which at the time seemed to me like a stretch, but I’m very happy he did. I don’t have formal training in medical informatics and at the time I felt more aligned with general internal medicine, which continues to be very important to me. But Reed’s perspective was that informatics needed more evaluation, he assured me that I’d be welcome even if I didn’t know all the acronyms, and convinced me that what I could bring to the table was the ability to evaluate some of the things that were being built or developed.
I’ve always been interested in physician decision making and how that could be improved. It was clear to me early on that if we began to computerize things we could make suggestions to people that would help them improve the care that they were delivering.
What are your ambitions? At the end of your career, what do you hope to have accomplished?
Our group has shown that by computerizing prescribing that we can use medications much more safely and more efficiently. I’ve done a series of studies already suggesting that we can do that, and it is really exciting to see electronic prescribing spread across the country. I’d like to see that go well, and for providers everywhere to realize the levels of benefit we’ve seen within Partners. Most recently I’ve been involved with improving patient safety globally, and have led a program for the World Health Organization on research in patient safety, which is having an impact around the world. At the end of my career, I’d hope that the U.S. will have moved ahead with electronic records in general and medication-related issues in particular, and the safety is recognized that safety is a global issue, and that there are opportunities to improve it regardless of the level of development.
Who or what are your “key sources” in the informatics field?
There have been many people from AMIA who have inspired me. Reed Gardner is one of my heroes, with all his work on improving responses to lab tests, and on blood use, among many other areas. Clem McDonald, with his work on clinical decision support and “the imperfectability of man,” has been a role model. And Bill Tierney, who did a lot of the early work in electronic records demonstrating value, and then did all the remarkable work in Kenya, is an enormous inspiration.
Articles that spotlight my research interest …
My most important paper is probably one that was published in 1998 in JAMA,1 which is the one that showed that computer order entry substantially reduced the serious medication error rate by 55%. The initial papers from the ADE Prevention Study evaluated the epidemiology of adverse drug events, demonstrating their frequent occurrence in hospitalized patients and that 28% were preventable.2,3 Most serious errors occurred during ordering, which had a major impact on the way people viewed this issue—most prior work had excluded ordering errors. The second paper addressed systems analyses of individual errors, highlighting the importance of systems approaches to improving administration of medications, rather than targeting individuals. A subsequent 1997 JAMA paper demonstrated that the costs of adverse drug events were high, particularly the costs of preventable adverse drug events.4 Other important papers—all in the New England Journal--include a study showing that fatigued interns made more errors, which help change the work hours regulations,5 the study showing that bar-coding worked,6 and a review of the impact of information technology on safety.7
AMIA is important to me because ...
It’s the organization that brings together the broad array of providers who work in medical informatics and have an academic interest. Also because it’s an unbiased group that is really focused on improving care through the use of information systems in this country.
I am involved with AMIA ...
I’m a former Board Chair of AMIA, I have served as the representative of AMIA for the International Medical Informatics Association and I’m the former policy chair for AMIA.
It may surprise people to know ...
My biggest passion outside of work is birding. I’ve seen more than 6,000 of the world’s 10,000 species of birds, which has taken me all over the world. I also love hiking, climbing, extreme skiing, whitewater rafting, travel and duplicate bridge.
- Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA : the journal of the American Medical Association. Oct 21 1998;280(15):1311-1316.
- Bates DW, Cullen DJ, Laird N, et al. Incidence of adverse drug events and potential adverse drug events. Implications for prevention. ADE Prevention Study Group. JAMA : the journal of the American Medical Association. Jul 5 1995;274(1):29-34.
- Leape LL, Bates DW, Cullen DJ, et al. Systems analysis of adverse drug events. ADE Prevention Study Group. JAMA : the journal of the American Medical Association. Jul 5 1995;274(1):35-43.
- Bates DW, Spell N, Cullen DJ, et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA : the journal of the American Medical Association. Jan 22-29 1997;277(4):307-311.
- Landrigan CP, Rothschild JM, Cronin JW, et al. Effect of reducing interns' work hours on serious medical errors in intensive care units. The New England journal of medicine. Oct 28 2004;351(18):1838-1848.
- Poon EG, Keohane CA, Yoon CS, et al. Effect of bar-code technology on the safety of medication administration. The New England journal of medicine. May 6 2010;362(18):1698-1707.
- Bates DW, Gawande AA. Improving safety with information technology. The New England journal of medicine. Jun 19 2003;348(25):2526-2534.