On Tue, 2005-03-15 at 10:17, Daniel L. Johnson wrote:
> On Fri, 2005-03-11 at 05:36, J. Antas wrote:
> > The Journal of American Medical Association (JAMA) just published an
> > article by Koppel et al. about the impact of a widely used computerized
> > physician order entry (CPOE) system in facilitating medication errors at
> > a hospital. CPOE increased the probability of 22 potential sources of
> > prescribing error.
> >
> > Source URL: http://e-healthexpert.org/
> >
> http://jama.ama-assn.org/cgi/content/abstract/293/10/1197?etoc
>
Actually, the best entry to this discussion is via the editorial:
http://jama.ama-assn.org/cgi/content/full/293/10/1261
Some excerpts from this insightful editorial:
"Behind the cheers and high hopes that dominate conference proceedings,
vendor information, and large parts of the scientific literature, the
reality is that systems that are in use in multiple locations, that have
satisfied users, and that effectively and efficiently contribute to the
quality and safety of care are few and far between."
...
"The summary by Garg et al of 100 trials of clinical decision support
systems over a 6-year span is critical. About two thirds of the studies
claimed improved clinician performance, but these assessments were often
biased; when the authors were not also the system developers, less than
half of the systems showed an improvement. In fact, "grading oneself"
was the only factor that was consistently associated with good
evaluations."
...
"...the study by Koppel et al of users of a single CPOE system in a
large academic medical center identified 24 different types of failures
of which users were aware; roughly half the participants said these
faults occurred from several times per week to daily."
...
"These results are disappointing but should not be surprising. There is
a long-standing, rich, and abundant literature on the problems
associated with the introduction of computer technology into complex
work in other domains, as well as occasional notes in health care."
...
"To begin to move forward, it is necessary to dispense with the commonly
held notion that these problems are simply bits of bad programming or
poor implementation that can easily be excised or avoided the next time
around. ...these failures [involve] "not developing the right systems"
due to widespread but misleading theories about both technology and
clinical work."
...
"Simply having greater clinician participation in the design of these
technologies will not fix this problem. Most domain experts have little
insight into their own work processes or sources of expertise."
...
"...this lack of self-insight is the fundamental reason why system
developers cannot objectively evaluate the systems they have developed.
No matter how much they may try to be objective, the very process of
development and refinement has created in them hidden assumptions about
"the way things work" that make it impossible for them to envision some
of the ways in which things might go wrong when users who do not share
those assumptions interact with the system."
...
"Useful information technology is a sine qua non to bridging the
"quality chasm" that has been so clearly identified by the Institute of
Medicine and others.32 Yet an information technology in and of itself
cannot do anything, and when the patterns of its use are not tailored to
the workers and their environment to yield high-quality care, the
technological interventions will not be productive. This implies that
any IT acquisition or implementation trajectory should, first and
foremost, be an organizational change trajectory. This is true at both
the organizational level and the national level; a national health IT
infrastructure without a clear logic about how health care organizations
will become engaged in this infrastructure is bound to fail."
