Really agree on these. I had a 'which EMR should I get?' call from a
colleague yesterday. I told her that I still am not sure after all
these years of search but one thing that I am pretty sure of is that
the millions of federal grant dollars and high-end political attention
currently being given to this is a positive development but the likely
result is a whole lot of nothing to the average clinician. In the near
(10 year) term. I hope I am wrong.
-- IV
On Tue, 15 Mar 2005 08:25:30 -1000
"David Derauf" <[EMAIL PROTECTED]> wrote:
Sobering thoughts ...not at all surprising.
I am struck by the degree of "magical thinking" that so many of us
engage in
around HIT "solutions". Perhaps it will be the next generation who
have lost
our gee whiz naivety...
David Derauf
-----Original Message-----
From: Daniel L. Johnson [mailto:[EMAIL PROTECTED]
Sent: Tuesday, March 15, 2005 8:12 AM
To: OpenHealth List
Cc: Mark Deyo-Svendsen; Hank Simpson; Kathy Markham
Subject: Re: Role of CPOE Systems in Facilitating medication Errors
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."
