1. AMERICAN HOSPITAL ASSOCIATION, PATIENTS OR PAPERWORK? THE REGULATORY BURDEN FACING AMERICA'S HOSPITALS 4 (2001), at http://www.hospitalconnect.com/aha/advocacy-grassroots/advocacy/advocacy/ content/FinalPaperworkReport.pdf.
2. The terms health care provider and physician could be used almost interchangeably. For consistency, the term physician is used almost exclusively throughout the article. This article is also applicable to other health care providers such as hospitals, chiropractors, dentists, nurses, optometrists, and other licensed entities that provide health care. See George L. Slum, Medical Malpractice: Who Are "Health Care Providers" or the Like, Whose Actions Fall Within Statutes Specifically Governing Actions and Damages for Medical Malpractice, 12 A.L.R.5TH 1 (1993) (the rules and duties that govern liability determinations for physicians also apply to other health care practitioners).
3. Some hospitals and health systems are actually providing access to online services for their patients. Eleven percent of the most wired hospitals provide appointment scheduling; 39% provide physician referral; 4% provide prescription renewal; and 38% provide support groups online. 100 Most Wired Hospitals and Health Systems, HEALTH & HOSP. NETWORKS, Apr. 1,2000, at center sections, available at http://www.hhnmag.com. A September 1999 poll conducted by Harris Interactive reported that 70 million of the 97 million American adults who were online searched for health information on the Internet in the last year. INSTITUTE OF MEDICINE, CROSSING THE QUALITY CHASM: A NEW HEALTH SYSTEM FOR THE 21ST CENTURY 166 (2001).
4. INSTITUTE OF MEDICINE, To ERR Is HUMAN: BUILDING A SAFER HEALTH SYSTEM 1 (2000). According to three researchers from the Departments of Sociology and Psychology at the University of California at San Diego, there was an increase in medication errors between 1983 and 1993 based on a review of all United States death certificates through 1983 and 1993. David P. Phillips et al., Increase in U.S. Medication-Error Deaths Between 1983 and 1993, 351 LANCET 255, 255 (1998). Death certificates identify the cause of death, race, sex, and inpatient/outpatient status. According to their review in 1983, 2,876 people died from medication errors compared to 7,391 in 1993, a 2.57-fold increase. Further, outpatient medication error deaths had an 8.48-fold increase over the period. Id. In 1983, the proportion of deaths from medication errors was 3.0 times greater for outpatients than inpatients and, in 1993, the risk ratio increased to 6.5. Id. The ratio (1993 deaths/1983 deaths) for the nine pharmacological categories provided on death certificates were: analgesics, antipyretics, and antirheumatics-2.47; barbiturates-0.24; other sedatives and hypnotics-0.40; tranqirilizers-0.68; other psychotropics2.02; other central and autonomie nervous system drugs-4.10; antibiotics-0.77; anti-infectives1.00; and other drugs-2.80. Id.
5. To ERR Is HUMAN, supra note S, at 27. A 1993 study of adult patients at two large tertiary care hospitals in Boston, Massachusetts, found that, over a six-month period, an adverse drug event resulted in a $2,595 additional cost to the hospital. The study estimated that the annual cost of adverse drug events for a 700-bed teaching hospital was $5.6 million. The cost of preventable adverse drug events was $2.8 million per year (over half of the total even though preventable adverse drug events represent less than one third of the total). These estimates do not include the cost of the injuries to the patients, malpractice costs, or the cost of less serious medication errors or admissions related to adverse drug events. A separate study, also covering a six-month period, found the additional cost/total cost of a preventable adverse drug event was $5,857 and an increase of 4.6 days in the length of stay. David W. Bates et al., The Costs of Adverse Drug Events in Hospitalized Patients, 277 J.A.M.A. 307,307 (1997).