FAQs

Why is a medical error reduction program important?
Radiation oncology is an exceedingly complicated system where accidents, errors, near misses, sentinel events, failures, and adverse events happen. An error reduction program helps institutions improve process, minimize risk to patients, reduce liability, increase compliance, lower medical costs, and positively contribute to patient outcomes.

How many errors world-wide have been reported in radiation oncology?
Between 1976 and 2007, the World Health Organization (WHO) has recorded 7,741 incidents and “near misses”. Of these events, 3,125 incidents caused harm ranging from underdose (resulting in increasing risk of recurrence) to overdose (causing toxicity).^1
1WHO – World Alliance for Patient Safety, Radiotherapy and Oncology: International Review of Patient Safety Measures in Radiotherapy Practice; 2009: Vol. 92:1, 15-21.

Are all errors reported?
“… it is likely that many more incidents have occurred but either went unrecognized, were not reported to the regulatory authorities, or were not published in the literature.”^2
2ICRP, Radiological Protection and Safety in Medicine; ICRP Publication 73; 1996: Ann. ICRP 26 (2).

What is the reported error rate?
Error rates in radiation oncology are not well established. Reported error rates range from 0.1% to 0.2% of fields treated. Studies not relying on self-reporting show actual rates of up to 3%.^3
3French, J. Treatment Errors in Radiation Therapy. Radiation Therapist. Fall 2002; Vol.11 (No. 2).

Who reports the most errors in a radiation oncology center?
Of reported errors world-wide, radiation therapists at the treatment machine report 69% of all errors.^4
4Radiation Oncology Safety Information System (ROSIS) Database, 2010. http://www.rosis.info. Accessed April 29, 2010.

What does the WHO say about radiotherapy errors?
The potential for errors in radiotherapy is high. There is no consensus as yet as to how best to deal with errors not covered by regular system quality assurance checks. However, it is imperative that proper QA measures are in place in order to reduce the likelihood of accidents and errors occurring, and increase the probability that the errors will be recognized and rectified if they do occur. The WHO has started an initiative to develop a set of patient safety interventions addressing the high risk areas in the radiotherapy process of care.^5
5WHO – World Alliance for Patient Safety, Radiotherapy and Oncology: International Review of Patient Safety Measures in Radiotherapy Practice; 2009: Vol. 92:1, 1-4.

Why is the U.S. government getting involved?
According to the Institute of Medicine (IOM), medical errors result in 44,000 to 98,000 deaths per year in U.S. hospitals. The IOM found medical errors cost hospitals approximately $37.6 billion per year.⁶ Other studies show medical errors cost $50 billion a year in avoidable medical expenses, or approximately 30% of all health care costs.⁷ In the U.S. alone, adverse events occur to approximately 3 – 4% of patients.⁸ Consumers are concerned about the safety of health care. Federal and state governments are facing significant costs associated with preventable patient safety events. In radiation oncology, recently published incidents involving medical events in the U.S. have received increased public attention and Congressional scrutiny.
⁶IOM, To Err is Human: Building a Safer Health System, The National Academies, 1999.
⁷Fixing Hospitals; Forbes. June 20, 2005.
⁸Doing What Counts for Patient Safety - Federal Actions to Reduce Medical Errors and Their Impact. http://www.quic.gov. Accessed April 26, 2010.

How is the U.S. government getting involved?
The Healthcare Research and Quality Act of 1999 requires the Agency for Healthcare Research and Quality (AHRQ) to support research and partnerships in identifying causes of errors, creating strategies to reduce errors, and disseminating strategies for patient safety. The Patient Safety and Quality Improvement Act (2000) helps create state patient safety centers in 27 states and DC. Five patient safety advisory groups have since been created. In 2002, the National Quality Foundation (NQF) issues a list of reportable events. Next, safety indicators are established by AHRQ in 2003. In 2004, The Joint Commission and CMS sign a working agreement to align hospital quality measures. Through the Medicate/State Children’s Health Insurance Program Quality Initiative, CMS contracts with quality improvement organizations in 2005 and created pay-for-performance (P4P). The Medicare Value Purchasing Act of 2005 further expands P4P. In 2006, CMS requires that hospitals report quality data for payment. The Tax Relief Act of 2006 requires the OIG report adverse events to Congress. In addition, hospitals must develop a quality assessment and performance improvement (QAPI) program to receive Medicare and Medicaid payment. The Physician Voluntary Reporting Program (Physician Quality Reporting Initiative - PQRI) with financial incentives is implemented in 2007. In 2008, state associations and CMS no longer pay for certain conditions caused by medical errors. The National Priority Partnership (NPP) in 2008 deems error reduction as 1 of 6 national priorities. In 2009, NPP endorses safety measures, safe practices, and reportable events. In 2012, through the Affordable Care Act (ACA), Health and Human Services will start a value-based purchasing program for meeting certain performance measures. This reward program will apply to certain cancer treatment centers. In addition, a new program called Quality Reporting for PPS (Prospective Payment System)-Exempt Cancer Hospitals will begin in 2012. The ACA will establish a new quality measurement and reporting program for cancer hospitals that are exempt from the PPS. Improvements to PQRI through ACA will continue through 2014. Meaningful Use of EHRs will continue with existing and newly developed quality measures. Public Reporting of Performance Information (Physician Compare Website) will remain an important part of the ACA. For additional information on patient safety and initiatives by the federal government to reduce medical errors, please visit the History of Medical Errors page.

How do hospitals comply?
Hospitals must measure, analyze, and track quality indicators, including adverse patient events. Hospitals must also implement preventive actions and mechanisms with feedback and feedback/learning throughout the hospital. To ensure compliance, state survey agencies perform surveys and review functions for Medicare. In turn, hospitals are encouraged to report adverse events to Patient Safety Organizations (PSO). PSOs are public, private for-profit, and not-for profit organizations. AHRQ validates PSOs by certifying that PSOs have process to collect and analyze reported events. PSOs report data to the Department of Health and Human Services.

How can MERP help?
An important element in establishing an organizational culture of patient safety includes the creation of an environment in which errors are openly identified and reported. MERP is an effective tool in helping create a culture of patient safety. MERP is a medical error reduction software program specifically designed to help minimize errors, improve performance, increase quality, and reduce regulatory infractions in the radiation oncology treatment delivery process. MERP serves as a ready-made tool for reducing preventable system-related errors by helping identify errors, measuring improvement, and increasing patient safety.

What does MERP do?
MERP software provides a comprehensive, interactive process for managing risk and making systems improvement. MERP is a powerful tool for implementing proactive risk reduction through error analysis and action plans. MERP facilitates a comprehensive approach to improving patient safety through the reduction of preventable systems-related errors. MERP empowers the user in these following key aspects: (1) defines the roles and responsibilities of key individuals, (2) characterizes the critical elements for managing mistakes, (3) measures process improvement, (4) provides a road map for error evolution and documentation, and (3) builds step-by-step benchmark procedures based on lessons learned from actual errors, not irrelevant or immaterial policies that are not being followed.

Does MERP Perform Root Cause Analysis?
Yes, MERP does a thorough and credible root cause analysis. Root cause analysis is a process for identifying the basic or casual factor(s) underlying performance, including the occurrence and potential occurrence of a sentinel event, medical event, or regulatory infraction. The root cause is defining the fundamental reason for the failure or inefficiency of a process. The analysis involves understanding the contributing factors and the fundamental reasons why the problem has occurred. Fundamentally, root cause analysis is used to uncover the underlying factors that lead to errors, failures, or inefficiencies. Root cause analysis also applies to causation associated with less-serious errors and near misses. Root cause analysis helps radiation oncology centers prevent system-related failures.

What are the benefits of MERP?
MERP serves as a critical tool in the quest to reduce mistakes. Without an error reduction program, centers run a greater risk of exposure to disadvantageous and potentially injurious consequences. MERP provides a solution for reducing risk to your center:

1. Help minimize the occurrence of medical or sentinel events, and possible patient/physician litigation,
2. Provide a system for assessing tangible and measurable improvements in patient safety,
3. Help prevent violations of state and federal radiation safety regulations,
4. Employ a program of “self-identification” to preclude citing of violations by state, NRC, or CMS inspectors,
5. Mitigate sanctions and enforcement (e.g., civil penalties and newspaper releases) levied by state and NRC inspectors,
6. Comply with fraud/abuse laws related to Medicare reimbursement for errors in charge capture and billing activities,
7. Reduce facility liability and physician malpractice insurance premiums,
8. Help fulfill facility certification standards as established by The Joint Commission, ACR, ACRO, and certain state agencies,
9. Define a system of “who is responsible for a particular process, action plan, and error approval”,
10. Provide a system for modifying or creating new department procedures based on action plans from actual medical events,
11. Meet various state and federal initiatives to reduce medical errors, increase patient safety, and decrease unwarranted expenses, and
12. Provide a continuous improvement model for increasing quality, lowering medical costs, and increasing profitability.

Is MERP only for large centers?
No, MERP can be a very effective tool for use in small radiation oncology centers or clusters of small/medium size centers. Unlike large centers, small individual centers or clusters of centers have limited resources. For example, small centers may have employees and physicians (such as Nurses, Therapists, Dosimetrists, Physicists, and Radiation Oncologists) working part-time or locums working under contract. In cases where there are multiple centers,  employees and physicians may support centers located in different geographical areas. In both scenarios, single or multiple centers are often under pressure to contain costs. Tracking of errors in MERP helps identify problem areas at the center level and allows for more effective and cost effective utilization of your limited resources throughout your organization. Whether one or multiple centers, MERP creates scales of efficiency that best optimizes allocation and deployment of your staff and physicians.

Is MERP only for small centers?
No, MERP is very useful in large radiation oncology centers or hospitals due to the increased number and sophistication of procedures. Large centers or hospitals may have a number of employees dedicated for QA purposes. However, it is often difficult to determine where the procedural breakdown occurs in large, detailed processes. For example, can the adverse event be traced to a particular department?  Are there multiple causative factors such as training or lack of adequate procedures?  Is it isolated to one hospital or could it be recurring at others?  In short, MERP provides a process for analyzing fundamental reasons for the failure or inefficiency at large institutions as well as multiple hospitals within corporations. Risk reduction strategies can be more effectively deployed across a large organization and any of its affiliates or satellites.

Will you customize MERP for my center?
Yes, we will help you configure MERP for your center’s treatment delivery methods (conventional EBRT, 3D-CRT, IMRT, SRS, and SBRT). This includes configuring specific roles, users, categories, subcategories, and attributes in MERP.

Will you install MERP?
Yes, we will install MERP on your server and workstations. The server and workstations must meet minimum requirements to host MERP.

What are the minimum server and workstation requirements to host MERP?

     Server

• Processor: (Dual) Intel® Xeon® 5130 Dual Core Processors at 2.0 GHz, 1333MHz FSB with 4 MB cache; or better
• Memory (RAM): 2 GB
• Hard Drive (Local Storage): 2x36 GB (OS/APP) Hot Swap drives with Serial Attached SCSI interface at 10,000 RPM
• Drive Controller: Single channel SAS RAID controller. Configured for hardware RAID 1 fault tolerance.
• Network Interface: 1 Ethernet NIC 100/1000 Mbps
• Redundancy: PSU and Fans
• Ports: Minimum 2 USB
• Operating System: Microsoft® Windows® Server 2003 R2 Standard Edition (English version only), Service Pack 2
• File System: NT File System (NTFS)
• Windows® OS Architecture: 32-bit
• Microsoft® SQL Server: SQL 2005; or newer

     Workstation

• Processor: (Single) Intel® Core™ 2; or better
• Memory (RAM): ≥ 1GB
• Hard Drives (Local Storage): ≥ 40GB
• Operating System: Windows XP Professional SP2; or newer

Will I be trained in MERP?
Yes, onsite applications training is performed with staff and physicians. This initial training is included in the purchase price. Additional training can be purchased separately.

Can I receive continuing education credits for my training in MERP as a therapist?
Yes, the onsite training has been approved by ASRT for 6.0 hours of Category A credits.