Computers Make Medicine Harder
Posted by
Kevin
Unless you really work at integrating them:
linical information technology systems – especially those known in the health care industry as computerized provider order entry (CPOE) systems – promise to improve health outcomes, reduce medical errors and increase cost efficiency, but hospitals adopting them must plan for “immense” workflow issues and a host of other unanticipated consequences that come with them or face potentially crippling problems, concluded a study led by researchers at Oregon Health & Science University.
The researchers found in a survey of 176 hospitals where CPOE systems have been integrated into daily operations that unintended adverse consequences were virtually universal. CPOE systems are those that require a physician or other health care professional to enter prescriptions and other medical orders directly into a computer database.For six out of eight previously defined categories of unintended consequences, more than 70 percent of the institutions ranked the level of impact on operations as “moderately to very important.” Those were issues involving alterations in workloads, workflow, communication patterns, never ending system demands, emotions and system overdependence that led to havoc during system failures. Doctors, for example, were spending much more time at the computer inputting prescriptions and other orders.
One of the reason the VA does so well compared to private systems is that it has a wonderful computerized record keeping system. Nut the VA is not like a private hospital. It has enormous incentives to reduce costs (since it is a government program dealing with veterans, and under great scrutiny as a result) and it generally has a patient in the system from their first visit to their death. Hospitals and private practice have neither advantage. Training is a short term drain on profits with a pay off that can only bessen far down the road and patients are truly transitory. It is rare for a patient to stay with one hospital or private practive for a significant amount of time.
Unfortunately, these problems are preventing the adoption of system that literally save lives:
At least 400,000 preventable drug-related injuries occur in hospitals each year, the Institute of Medicine of the National Academies reported last year, and illegible handwritten prescriptions figure in a significant share of them. Prescriptions ordered electronically are safer and, combined with decision support tools, automatically alert prescribers to possible interactions, allergies and other potential problems, the Institute said, and urged that all health care providers have electronic systems in place by 2010.
Fears that the CPOE “cure” might be worse than the disease likely are impeding the diffusion of CPOE throughout hospitals in the United States, the authors of the JAMIA paper asserted. Those fears gained credence when a pediatrics hospital in Pittsburgh attributed a higher mortality rate to its CPOE system—mistakenly, it later turned out—and when Cedars-Sinai Medical Center in Los Angeles, hospital of the stars, shelved its $34 million system after a staff revolt.
One small advantage of a single payer system might — and I stress might as the political will to enforce this change would have to be present — force private practioners to use these kinds of systems as they are both a life and cost saver.
