A decade after the Institute of Medicine landmark report on medical errors, titled "To Err is Human," an expert in medical errors and patient safety gives the nation's progress a B-minus, with health IT falling slightly behind with a "C+".

Patient safety has improved from five years ago, when Robert M. Wachter, a professor and associate chairman in the department of medicine at the University of California, San Francisco, gave patient safety efforts a "C+".

Wachter, who has authored two books on patient safety and is editor of the federal government's two leading safety Web sites, provided his analysis in an article published in Health Affairs.

Wachter said the past decade has seen progress in hospitals' responses to pressures like accreditation, regulation and error reporting, but health IT has lagged behind, with research in the area hindered by a lack of funding.

Health IT's grade is a slight drop from five years ago, when Wachter gave it a "B-".

Wachter said he sees an almost static situation and "increasing evidence of health IT-related safety hazards and implementation challenges."

"Health IT is harder than it looks," he said. "The most hopeful development is federal engagement."

With funds directed toward health IT through President Barack Obama's stimulus package, Wachter anticipates future improvements in this area.

He cites several early missteps in the patient safety field, including the implementation of residency duty-hour reductions without an attempt to improve procedures when residents sign out; and the national requirement to implement medication reconciliation in the absence of clear guidelines regarding how to accomplish it.

Wachter concludes that most changes have constituted real progress.

"[E]ven our missteps ... have yielded valuable lessons," he said. Moreover, given the complexity of the healthcare system, he said, "had I been asked in 1999 how much change in patient safety-related areas would be possible within a decade, I would have substantially underestimated our actual accomplishments."