Godot

Doctors’ Journal Says Computing Is No Panacea | NYT | 3.9.05

The Bush administration and many health experts have declared that the nation’s health care system needs to move quickly from paper records and prescriptions into the computer age. Modern information technology, they insist, can deliver a huge payoff: fewer medical errors, lower costs and better care.

But research papers and an editorial published today in The Journal of the American Medical Association cast doubt on the wisdom of betting heavily that information technology can transform health care anytime soon.

One paper, based on a lengthy study at a large teaching hospital, found 22 ways that a computer system for physicians could increase the risk of medication errors. Most of these problems, the authors said, were created by poorly designed software that too often ignored how doctors and nurses actually work in a hospital setting. …

Drug-error risk at hospitals tied to computers | Boston Globe | 3.9.05

Hospital computer systems that are widely touted as the best way to eliminate dangerous medication mix-ups can actually introduce many errors, according to the most comprehensive study of hazards of the new technology. The researchers, who shadowed doctors and nurses in a Philadelphia hospital for four months, found that some patients were put at risk of getting double doses of their medicine while others get none at all. …

Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors | JAMA | 3.9.05

Conclusions In this study, we found that a leading CPOE system often facilitated medication error risks, with many reported to occur frequently. As CPOE systems are implemented, clinicians and hospitals must attend to errors that these systems cause in addition to errors that they prevent.

Advantages of CPOE Systems Compared With Paper-Based Systems

1. Free of handwriting identification problems
2. Faster to reach the pharmacy
3. Less subject to error associated with similar drug names
4. More easily integrated into medical records and decision-support systems
5. Less subject to errors caused by use of apothecary measures
6. Easily linked to drug-drug interaction warnings
7. More likely to identify the prescribing physician
8. Able to link to ADE reporting systems
9. Able to avoid specification errors, such as trailing zeros
10. Available and appropriate for training and education
11. Available for immediate data analysis, including postmarketing reporting
12. Claimed to generate significant economic savings
13. With online prompts, CPOE systems can
14. • Link to algorithms to emphasize cost-effective medications
    • Reduce underprescribing and overprescribing
    • Reduce incorrect drug choices

Our qualitative and quantitative research identified 22 previously unexplored medication-error sources that users report to be facilitated by CPOE. We group these as:

Information Errors: Fragmentation and Systems Integration Failure

1. Assumed Dose Information
2. Medication Discontinuation Failures
3. Procedure-Linked Medication Discontinuation Faults
4. Immediate Orders and Give-as-Needed Medication Discontinuation Faults
5. Antibiotic Renewal Failure
6. Diluent Options and Errors
7. Allergy Information Delay
8. Conflicting or Duplicative Medications

Human-Machine Interface Flaws: Machine Rules That Do Not Correspond to Work Organization or Usual Behaviors

1. Patient Selection
2. Wrong Medication Selection
3. Unclear Log On/Log Off
4. Failure to Provide Medications After Surgery
5. Postsurgery “Suspended” Medications
6. Loss of Data, Time, and Focus When CPOE Is Nonfunctional
7. Sending Medications to Wrong Rooms When the Computer System Has Shut Down
8. Late-in-Day Orders Lost for 24 Hours
9. Role of Charting Difficulties in Inaccurate and Delayed Medication Administration
10. Inflexible Ordering Screens, Incorrect Medications

Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes | JAMA | 3.9.05

Conclusions Many CDSSs improve practitioner performance. To date, the effects on patient outcomes remain understudied and, when studied, inconsistent.

Vladimir: Well, shall we go?
Estragon: Yes, let’s go.
They do not move.

Computer Technology and Clinical Work | JAMA Editorial | 3.9.05

Still Waiting for Godot

Process-supporting information technology (IT) has been heralded as an important building block in attempts to improve the quality and safety of health care. Two areas in particular have drawn both attention and funding. The first is clinical decision support; that is, information systems designed to improve clinicians’ decision making. The second is computerized physician order entry (CPOE) as a means for reducing medication errors. The literature in these fields has been characterized by frequent reports of success, often accompanied by predictions of a bright new (and near) future; however, the future seems never to arrive. 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…

Estragon: Let’s go.
Vladimir: We can’t.
Estragon: Why not?
Vladimir: We’re waiting for Godot.
Estragon: (despairingly). Ah!