Content Study of Error Rates and EQR by Keith Torkelson, MS, BS VBND
Success Rate’s Relationship to Error Rate
Understanding the Relationship between Success Rate and Error Rate: Success rate and error rate are two sides of the same coin when measuring performance, particularly in fields like usability testing, quality control, and machine learning. They are inversely related, meaning that a higher success rate generally corresponds to a lower error rate, and vice versa.
Results Up Front
Pertains to Keith Edward Torkelson, MS, BS
Sample of Error Rates - Proof I make / made Errors
Keith “Buster” Torkelson’s Measured Error Rates
Analysis
Dimensional analysis is a technique for checking unit consistency in equations and converting between units by treating them like algebraic variables that cancel out. It involves multiplying a measurement by a conversion factor (a ratio of equivalent quantities in different units) until the desired units remain. This method is widely used in science and engineering to verify formulas, simplify complex calculations, and ensure accurate unit conversions in various applications, from physics to medicine.
Error % = 100% - Percent Correct
Summary – My Errors
>As you can see in this paper that: Over the course of my life I have made several quantifiable errors. I have made even more errors that I did not address here. I chose pedagogical errors because most of the results are objective. I learned that it’s too late in life to really improve on my quantifiable errors with respect to my education. From the table Keith Torkelson’s measured Error Rates you will notice that my grade point average across all of Orange County is a 4.0. I am most proud of my score on the quantitative portion of the GRE examination where my quantitative score comes out to 800 out of 800 or I’m in the 99th percentile. This paper was stimulated by the fact that one of my doctors has difficulty getting one or more of my prescriptions right each time. I believe his errors fall mostly under communication errors.
Errors
>While researching this paper I found out for the first time about the ISMP or Institute for Safe Medication Practices. They take even the smallest error seriously. I probably will not report formally to them directly any of the errors that impact me. In this paper we offer up a standard definition for medication error. It is proposed by the National Coordinating Council for Medication Error Reporting and Prevention. The primary error that my doctor has been making is communicating what he prescribes for me to the pharmacy. On several instances he failed to put down the number of refills. In general his staff remedies the situation. Since 1989 when I first was put on a psychotropic medication several doctors have made errors. The cost was that some of these medication errors were strongly associated with me admitted to the hospital.
Specialists and Gratitude
>In this report we address the CMS star system. As a special topic we address physician burnout were literature indicates there appears to be an epidemic of physician burnout. One study indicates that physician burnout is one of the driving forces in making medical errors. Another special topic is addressing which physician’s specialty is the happiest. Depending on the year the five happiest specialties change each year. Back in 1996 we attended what is called Red Meat School or basic livestock slaughter inspection. Our average grade was 94.5 across eight areas. In closing we address a letter that was sent to us by a compliance officer for the effort we put in on her behalf, we were very grateful to receive recognition. This is the end of the summary.
Mitigation
>In my effort to resolve these errors and potential future errors we intend to identify, prioritize, and adjust the root causes of the errors. One of the root causes of the errors is that the doctor does not go over the prescriptions and ping the pharmacy that they have received all some odd 8 prescriptions each cycle. Obviously, we don’t want errors from any of our specialists and most of them have low error rates. When looking back at the data we have that includes errors we figure the potential cause is how fast the doctor has to get people in and out of the office. He is needed in the short-handed profession of psychiatry. We now get to plan ahead for his retirement.
Solution or Fixes
>The targeted solution we have been using is that we get a hard copy of the Visit Summary which includes any massaging of medications and we review it before we leave the clinic. Next, if there is an error we bring it to the attention of the clerical staff. It becomes more difficult if we fail to leave the office without the correct prescriptions lined up. The doctor making these errors has no quality assurance program. We would suggest that he derives a survey based upon the approach of an online rating service. The primary mitigation effort is that we double check the results from the appointment before leaving the building. Once again we’d like to be issued some sort of an assessment indicating our satisfaction with that day’s service. The highest risk medical errors are those associated with our sleep medications without sleep medication we don’t sleep and if we don’t sleep we become symptomatic of behavioral health issues then our judgment is impaired - so it is important to get the prescriptions right. So pretty much the fix is to expect errors and correct them on our side as needed. A year without medication errors would constitute a solution.
Scholastic Record (1987)
Keith E Torkelson
Why report on medication errors?
Reporting medication errors is crucial for improving patient safety by identifying system weaknesses, preventing future occurrences, and fostering a learning culture within healthcare organizations. Detailed reports allow for root cause analysis, enabling the implementation of preventative strategies, the development of new protocols, and the education of healthcare professionals to reduce the risk of harm from preventable medication-related events.
Segue - Types of Medication Errors
Taxonomy of Medication Errors Now Available (19 Pages)
http://www.nccmerp.org/sites/default/files/taxonomy2001-07-31.pdf
- 10 Patient Information
- 20 The Event
- 24 Setting (Where Error Perpetuated)
- 25 Description of Event
- 30 Patient Outcome
- 31 No Error
- 32 Error, No Harm
- 33 Error, Harm
- 50 Product Information - #1 [Product That Was Actually (Or Potentially) Given]
- 51 General
- 52 Dosage Form
- 53 Packaging – Container
- 54 Pharmacologic - Therapeutic Classification
- 55 Product Information - #2 (Product That Was Intended To Be Given)
- 56 General
- 57 Dosage Form
- 58 Packaging – Container
- 59 Pharmacologic - Therapeutic Classification
- 60 Personnel Involved
- 70 Type
- 80 Causes
- 81 Communication
- 83 Name Confusion
- 85 Labeling
- 87 Human Factors
- 89 Packaging/Design
- 90 Contributing Factors (Systems Related)
Questionnaire NCC MERP Taxonomy of Medication Errors
Gilbert Pharmacy Error
20201210-TH
>Clozapine Sent 30 in a bottle labeled 60 > Quantity Error > Remedy “Nick” our single point contact go to guy with pharmacy. Relatively insignificant because they sent some. There error rate since 2012 is less than 1%.
2021 Expectations
>We expect 2 medication errors for the whole year one error by the pharmacy another error by the doctor. Based on 2020 experiences, we don’t expect to bother our doctor outside of his office hours. We expect to receive no invoices from our doctor. Invoices would help with our accountability reports.
Institute for Safe Medication Practices (ISMP)
Leading the effort to prevent medication errors and adverse drug events
Report Errors
https://home.ecri.org/pages/ecri-ismp-error-reporting-system
Taking it to the next level > Report Medication Error
Report Medication Error to ISMP
Reporting a Medication or Vaccine Error or Hazard to ISMP. Thank you for your willingness to report a medication or vaccine error or hazard to ISMP. Medication Error Reporting Program.
Reporting a Medication or Vaccine Error or Hazard to ISMP
To report a medication or vaccine error or hazard to the Institute for Safe Medication Practices (ISMP), you can use the confidential reporting forms on the ECRI website. There are separate forms for the ISMP National Vaccine Errors Reporting Program (VERP) and the ISMP National Medication Errors Reporting Program (MERP), which also accepts reports from consumers. Alternatively, you can email reportmedsafetyerror@ecri.org to submit a confidential report. Thank you for your willingness to report a medication or vaccine error or hazard to ISMP.
FYI - ISMP- Institute for Safe Medication Practices
Healthcare Practitioner's Vaccine Error Reporting Form (ECRI)
https://www.ismp.org/form/verp-form
verp-form
Use the form below to report an error or hazard to the ISMP National Vaccine Errors Reporting Program. If you want to report a non-preventable adverse reaction to a vaccine product, please visit the US Department of Health and Human Services Vaccine Adverse Event Reporting System (VAERS) (http://vaers.hhs.gov).
Consumer's Medication Error Reporting Form (ECRI)
https://www.ismp.org/form/cmerp-form
cmerp-form
Use the form below to report a medication error to the Institute for Safe Medication Practices. Please answer the questions as completely and accurately as…
MERP = Medication Error Reporting Program
MERP, or Medication Error Reporting Program, is a system used by healthcare professionals to anonymously report and share information about potential or actual medication errors, facilitating analysis and the development of prevention strategies to improve patient safety. While some MERP programs are specific to individual organizations, others, such as the ISMP MERP, are national programs that collect detailed information to identify systemic weaknesses and drive national medication safety initiatives.
[PDF] - CMS Manual System
https://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/downloads/R77SOMA.pdf
Dec 22, 2011
Accepted Standards of Practice
Hospital policies and procedures for the preparation and administration of all drugs and biologicals must not only comply with all applicable Federal and State laws, but also must be consistent with accepted standards of practice based on guidelines or recommendations issued by nationally recognized organizations with expertise in medication preparation and administration. Examples of such organizations include, but are not limited to:
National Coordinating Council for Medication Error Reporting and Prevention
Institute for Healthcare Improvement
U.S Pharmacopeia
Institute for Safe Medication Practices, which offers guidelines specifically on timely medication administration, which can be found at:
www.ismp.org/Newsletters/acutecare/articles/20110113.asp
Infusion Nurses Society
National Coordinating Council for Medication Error Reporting and Prevention
The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) is an independent body composed of 27 national organizations.
Safe Use
In 1995, the United States Pharmacopeial Convention (USP) spearheaded the formation of the National Coordinating Council for Medication Error Reporting and Prevention: Leading national health care organizations are meeting, collaborating, and cooperating to address the interdisciplinary causes of errors and to promote the safe use of medications. USP is a founding member and the Secretariat for NCC MERP.
What is a Medication Error? – Standard Definition
The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). "A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing, order communication, product labeling, packaging, and nomenclature, compounding, dispensing, distribution, administration, education, monitoring, and use." “The Council” urges medication errors researchers, software developers, and institutions to use this standard definition to identify errors.
Taxonomy
Provides a standard language and structure when analyzing medication error reports.
FYI - See Taxonomy
http://www.nccmerp.org/sites/default/files/taxonomy2001-07-31.pdf
See Category Index
Types of Medication Errors
The Council realized the need for a standardized categorization of errors. On July 16, 1996, the NCC MERP adopted a Medication Error Index that classifies an error according to the severity of the outcome. It is hoped that the index will help health care practitioners and institutions to track medication errors in a consistent, systematic manner.
Medication Error Index
The index considers factors such as whether the error reached the patient and, if the patient was harmed, and to what degree. The Council encourages the use of the index in all health care delivery settings and by researchers and vendors of medication error tracking software. The ISMP Medication Errors Reporting Program (link is external) has implemented this index for use in its database.
NCC = National Coordinating Council “The Council”
MERP = Medication Error Reporting and Prevention
NCC MERP
The National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP) is an independent body composed of 27 national organizations. In 1995, the United States Pharmacopeial Convention (USP) spearheaded the formation of the National Coordinating Council for Medication Error Reporting and Prevention: Leading national health care organizations are meeting, collaborating, and cooperating to address the interdisciplinary causes of errors and to promote the safe use of medications.
USP is a founding member and the Secretariat for NCC MERP.
The United States Pharmacopeia (USP) is a founding member and serves as the Secretariat for the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP). USP led the council's formation in 1995 to bring national healthcare organizations together to address medication errors and promote safe medication use. As Secretariat, USP plays a significant role in coordinating the council's efforts and activities.
Taxonomy of Medication Errors Now Available (19 Pages)
http://www.nccmerp.org/sites/default/files/taxonomy2001-07-31.pdf
When you are finished reviewing the document, please print, fill out and return the short questionnaire found on the last page of the taxonomy.
Description of Event
This is a free text entry field. The user should provide a narrative description of the event, Including how the error was perpetuated and discovered. Other relevant information should be included, such as:
- Laboratory data or tests, including dates
- Other relevant history, including preexisting medical conditions (e.g., allergies)
- Concomitant therapy
- Dates of therapy
- Indication for use (Diagnosis)
- Medical intervention(s) following the error
- Actions taken and recommendation for prevention
Concomitant Therapy
Concomitant drugs are two or more drugs used or given at or almost at the same time (one after the other, on the same day, etc.). The term has two contextual uses: as used in medicine or as used in drug abuse.
Medication Error Register – Sample
Cost of Medication Errors
Medication errors are a significant and costly problem, both globally and in the United States. The World Health Organization (WHO) estimates global annual costs of $42 billion. In the U.S., estimates vary but suggest annual costs in the tens of billions of dollars, including hospital costs from adverse drug events and broader societal impacts. These costs stem from patient harm, increased length of stay, additional treatments, and lost wages and productivity.
Other Medical Errors - Indirect
Other types of medical errors include equipment and device malfunctions, infections, communication failures between staff, patient falls, and improper patient discharge leading to adverse outcomes. Other, more specific errors can involve birth injuries, leaving foreign objects in a patient's body during surgery, and misinterpreting laboratory results.
Brand New Day Related Errors
Insurer Roughly 2012-2023
Interpret 2.5 CMS Stars
A CMS star rating of 2.5 means the organization's performance is below average compared to other organizations nationally, but not at the lowest possible level. The exact interpretation depends on the type of facility or plan being rated, such as a nursing home, home health agency, or Medicare Advantage plan.
Aside - CalOptima CMS Stars - Not
What is the star rating of CalOptima?
(September 15, 2023) — CalOptima Health is pleased to announce its rating of 4 stars out of 5 stars in the National Committee for Quality Assurance's (NCQA) Medicaid Health Plan Ratings 2023. This is our current (2025) insurer for health needs.
Compare NCQA with CMS Stars Scoring
NCQA and CMS Stars are distinct healthcare quality measurement systems: NCQA's Health Plan Ratings (HPR) evaluate health plans across commercial, Medicare, and Medicaid sectors using HEDIS measures and other criteria, while CMS Stars Ratings focus specifically on Medicare Advantage and Part D plans, incorporating HEDIS, patient experience (CAHPS), and other program-specific features to provide a 1-5 star rating. While both use national benchmarks and score on similar measure types (outcomes, process, access) with different weights, HPR uses a percentile-based scoring system, and CMS Stars use a clustering algorithm for HEDIS measures. A key difference is that CMS Stars include bonus points for consistently high overall performance, a "Reward Factor," and allow for direct enrollment changes based on a plan's rating, while HPR grants bonus points for achieving NCQA Accreditation status.
For Medicare Advantage (MA) and Part D plans
For Medicare plans, a 2.5-star rating indicates below-average performance based on an evaluation of multiple measures.
These measures often include
Preventive care
The frequency of preventive screenings and vaccinations depends on a person's age, gender, medical history, and risk factors. While an annual wellness visit with a primary care provider is recommended for all adults, specific tests and immunizations vary.
Annual Wellness Visit
Most health plans, including Medicare, cover one annual wellness visit to create or update a personalized prevention plan. This visit is not a traditional physical exam but focuses on risk assessment and health goals.
Data shows that many people with long-term conditions do not receive the recommended tests and treatments, with significant racial and ethnic disparities in care. While utilization is slowly increasing due to programs like Medicare's Chronic Care Management (CCM), overall adoption remains low among eligible members.
An organization's plan for handling customer complaints and appeals is well-regarded when it is accessible, fair, timely, and focused on learning from mistakes. The overall quality can be assessed by examining the process itself, tracking key metrics, and reviewing the customer's experience.
Most Americans give their health plans a positive rating, but overall satisfaction is mixed and declining among some groups. Recent studies show that satisfaction is strongly tied to factors like affordability, ease of access to care, and quality of customer service.
Important considerations
No matter the specific plan or provider, it's important to remember that star ratings should not be the only factor in your decision.
Physician Error Rate By Specialty
Nearly 1 in 6 Docs Say They Make Diagnostic Errors Every Day
https://www.medscape.com/viewarticle/917784
Sep 10, 2019
That number varied by specialty. Pediatricians were less likely to say they made diagnostic errors every day (11%) and emergency medicine (EM) doctors were more likely, at 26%. In between were physicians in family medicine (18%), general practice (22%), and internal medicine (15%).
Medical errors may stem more from physician burnout than unsafe health care settings
Jul 8, 2018 [RECOMMENDED READ]
The epidemic of physician burnout may be the source of even more medical ... odds of self-reported medical error, after adjusting for specialty, work hours…The study also showed that rates of medical errors actually tripled in medical work units, even those ranked as extremely safe, if physicians working on that unit had high levels of burnout. This indicates that burnout may be an even a bigger cause of medical error than a poor safety environment, Tawfik said.
Resident physicians' clinical training and error rate: the roles of autonomy, consultation, and familiarity with the literature
https://pubmed.ncbi.nlm.nih.gov/24728954/
by E Naveh · 2015 · Cited by 18
Apr 12, 2014
Resident physicians' clinical training poses unique challenges for the delivery of safe patient care. Residents face special risks of involvement in medical errors since they have tremendous responsibility for patient care, yet they are novice practitioners in the process of learning and mastering their profession. The present study explores the relationships between residents' error rates and three clinical training methods (1) progressive independence or level of autonomy, (2) consulting the physician on call, and (3) familiarity with up-to-date medical literature, and whether these relationships vary among the specialties of surgery and internal medicine and between novice and experienced residents.
Supportive and Judgment Free
142 Residents in 22 medical departments from two hospitals participated in the study. Results of hierarchical linear model analysis indicated that lower levels of autonomy, higher levels of consultation with the physician on call, and higher levels of familiarity with up-to-date medical literature were associated with lower levels of resident's error rates. The associations varied between internal and surgery specializations and novice and experienced residents. In conclusion, the study results suggested that the implicit curriculum that residents should be afforded autonomy and progressive independence with nominal supervision in accordance with their relevant skills and experience must be applied cautiously depending on specialization and experience. In addition, it is necessary to create a supportive and judgment free climate within the department that may reduce a resident's hesitation to consult the attending physician.
Resident Physicians
Resident physicians are medical school graduates undergoing intensive, hands-on, supervised training in a specialized field of medicine through a residency program. These programs, also known as Graduate Medical Education (GME), provide essential clinical experience and increasing autonomy in patient care, lasting from three to seven years or more, depending on the chosen specialty. Residents work under the guidance of experienced attending physicians and are referred to as interns in their first year, providing care, performing procedures, and learning to become independent practitioners.
People also ask
Which physician specialty is happiest?
5 Happiest Types of Doctors | Med School Insiders
https://medschoolinsiders.com/medical-student/5-happiest-types-of-doctors/
Per Medscape's report, the happiest specialties at work were dermatology at number one, ophthalmology at number two, allergy and immunology at number three, followed by a three way tie between orthopedic surgery, psychiatry, and pulmonary medicine. Nov 10, 2019. Approximately 60% of physicians report feeling happy outside of work and 73% report that they would choose medicine again. Although this shouldn’t be used as an excuse not to address the issues within medicine and medical education, the situation is not as grim as some people make it out to be. According to Medscape’s 2020 Physician Lifestyle and Happiness Report, the specialties with the greatest proportion of happy physicians were rheumatology at number one followed by general surgery, public health & preventive medicine, allergy & immunology, and orthopedics. The bottom five were neurology, critical care, internal medicine, gastroenterology, and endocrinology. In 2019, the top 5 happiest specialties were rheumatology first, followed by otolaryngology, endocrinology, pediatrics, and general surgery and the bottom five were neurology, infectious disease, cardiology, pathology, and oncology.
Aside – Lived Experience - Circa 1980 – Highly Qualified
The Armed Services Vocational Aptitude Battery (ASVAB) is a multiple-choice test administered by the U.S. Military Entrance Processing Command to determine a person's qualification for enlistment in the Armed Forces. The test assesses academic abilities and predicts occupational success in various fields, with scores determining both eligibility to enlist and placement into specific military vocational roles. High school students in 10th, 11th, and 12th grades often take the ASVAB, which can be administered by computer or paper and pencil. No one service member qualifies for all duties in the military, as every role has distinct and specific requirements. Each branch of the U.S. Armed Forces has unique and rigorous standards for recruits, and even more stringent requirements for certain occupations like special forces, pilots, or explosive ordnance disposal (EOD).
USDA Slaughter Inspector Exams – Lived Experience - Circa 1996
To become a USDA slaughter inspector, you must pass a written test, meet education or work experience requirements (such as a bachelor's degree in a science field or related work experience), and then complete extensive USDA/FSIS training on food safety and inspection methods. The application process is handled through USAJOBS, and qualifying candidates then participate in training courses covering topics like humane slaughter, sanitation, hazard analysis, and foodborne illness prevention.
Quick Score Method for Physical Doctor Errors
No known "Quick Score Method" specifically for physical doctor errors exists. The search results do not reference any such method, and it is likely a misnomer. However, there are established methods for identifying and analyzing medical errors, including those related to physical examinations.
External Quality Review Error Checking
External Quality Review (EQR) error checking is the process by which an External Quality Review Organization (EQRO) validates the data and methodologies used by Managed Care Organizations (MCOs) to report on the quality of their services. The primary goal is to ensure that the data reported to state Medicaid agencies and the Centers for Medicare & Medicaid Services (CMS) is accurate, valid, and reliable.
External Quality Review
An External Quality Review (EQR) is an annual, independent review of a state's Medicaid and CHIP managed care plan performance, conducted by an External Quality Review Organization (EQRO) to assess the quality, timeliness, and access to healthcare services provided to beneficiaries. EQR is a mandatory requirement that includes validating performance improvement projects (PIPs), performance measures, and network adequacy, culminating in an annual technical report that informs the state's quality strategy and improvement efforts.
Real World – Pertains to J. Gibbs
>20160531 – Jessica R. says stick to it we will see how it goes with Gibb’s next visit – Next time he was a no show something we consider an error. This paper was initialized in the context of J. Gibbs our paid BND Helper. We asked him for help with housing and he never pulled through. Oswaldo Escalante before him had no trouble helping us with housing. We give Gibb’s 1.0 Stars to Escalante’s 5.0 Stars.
BND Corporate: “We appreciate your input”
It's a social interaction to show the person who thought of you that their gesture was appreciated or that you respect that person enough to acknowledge what they did for you. May 3, 2023
Example of Due Diligence on next page. (Great Memory)
Internal Quality Review Specialist
An Internal Quality Review Specialist evaluates products, services, or processes to ensure they meet internal standards, customer requirements, and industry regulations, performing audits and analyzing data to identify areas for improvement. This role often requires strong analytical skills, attention to detail, knowledge of quality control principles, and familiarity with relevant regulations. Specialists work across various sectors, including healthcare, manufacturing, and finance, to uphold efficiency, consistency, and compliance within an organization.
Errors and Performance Earned Value (PEV) – Extended
Dimensional Analysis | AMB | Quantitative | Error Translations & Qualitative |
Accounting | Ledger 2015 | 12 of 12 | 0% |
Analytical Ability | GRE | 720/800 | 10 |
Quantitative - Arithmetic | GRE | <1% 800/800 | <1% |
Computing | Days Primary Platform is Stable | 355/365 | 3% |
Computer Programming | Course Scores | For Grade GPA = 3.9 | For Pass – All Passes |
CSUF | GPA | 4.0 | 0% |
EIQ | 20200611 | 69.2% | 31% |
Quantitative - Geometry | 10th Grade and GRE | <5% 800/800 | <1 |
Grammar | Word | <5% Too High | |
Quantitative Ability | Graduate Records Examination (GRE) | 800 of 800 99th Percentile | <1% |
Health & Human Services | Learning | GPA = 4.0 | <1% |
Housing | History | 50% | 50% |
Information Technology | GPA = 3.9 | <5% | |
Injury | Blood processing | >10 Incidences | 10/57 = 18% |
Mensa – IQ (1996) | MGM & Last Test | 130/162 | 20% |
Legal | Criminal Record | 2 Items Age = 57 | 2/57 = 4% Too High |
Medata – Smart Coding | Error Rate Reports | <5% | <5% |
Medata – Billing Analyst | Error Rate Reports | <5% | <5% |
Appendix
Input from Reader
^That's an interesting assessment - have you thought about a summative final paragraph addressing what you've learned from all this analysis of your own errors and error rates in general? Seems like you have a lot of data on error rates and possible causes but I wonder what you think the next steps or mitigation measures are?
Writing a Summary
A structured approach to mitigation measures involves identifying, prioritizing, and addressing the root causes of errors. After analyzing the error data and identifying potential causes, the next steps include creating targeted solutions based on the type of error and then monitoring and refining the implementation process. Prioritize mitigation based on risk assessment. Not all errors are equal. Prioritize which ones to tackle first based on their potential impact and likelihood. Use a risk matrix to categorize each error based on these factors.
