Saturday, April 30, 2011

CPOE Cesspool

An accomplished physician who read my post on CPOE at Memorial Sloan Kettering causing medical errors and near misses, and lack of FD&C Act regulation of health IT medical devices, relates the following:

So I want to stop medications on a patient. The device only allows me to stop one at a time, and for each one, it requires me to type in a reason.

Then, I get another pop up screen to enter my password.

Six clicks and two manual entries to stop an aspirin, not counting the click to get to the med list. [What a valuable use of physician time! - ed.]

Also, I have found that when I want an order for something that is labor intensive to enter, and I ask house staff [trainees - ed.] to do it, I get balking as to why I want that treatment or infusion.

The arguments, I have found, are not really about the treatment. They are about their avoiding the pain in the ass of having to deal with the user unfriendly screens for that order.

The doctors all put up with this.

Yet for some reason this waste of valuable clinician time due
to antediluvian HIT design, and even wild goose chases for critical medications such as in my Apr. 5, 2011 post "Mission Hostile Health IT Obstructs Physicians From Ordering Life Saving Drugs In Critical Emergency", are considered "progress" in medicine.

World class medical centers such as Sloan Kettering consider CPOE a "critical vulnerability" towards near misses and outright medical errors.

Still, this IT toxicity is considered "progress" right up to our Department of HHS and POTUS.

Why?

-- SS

8 comments:

Peter said...

An electronic medical record saves time for every one except the people who care for patients and the patients themselves.To paraphrase Lewis Mumford, technology is often an expensive and temporary substituion for an effective social organization.

Scot M Silverstein MD said...

Peter said...

An electronic medical record saves time for every one except the people who care for patients and the patients themselves

I would rephrase that:

Today's ill conceived, poorly designed and atrociously implemented EMR's save time for every one except the people who care for patients and the patients themselves.

There are far better ways to design and implement clinical IT, but it takes brains the guys in the business suites lack.

-- SS

Stalwart Hospitalist said...

Rather than bemoan the current status of this one EMR that is configured, this physician should (1) inquire as to whether it can be configured to NOT require a reason for discontinue, (2) inquire as to whether it can be configured to allow multiple simultaneous discontinuations, and (3) if the answer to either (1) or (2) is "yes," why the system is configured the way it is. Often, situations such as these are due to the physician input (or lack of same) during the design and implementation phase, rather than any inflexibility of the EMR system itself.

Scot M Silverstein MD said...

Stalwart Hospitalist said...

I am living in a dream world

Or may as well have.

Would that it were so simple.

Solutions to severe, pervasive, systematic sociotechnical problems that produce atrocious, unfit-for-purpose IT that no level of "flexibility" will solve involve nothing less than a massive cultural reformation of the IT industry, mired in an archaic data processing culture.

Read here and here, for example, as to just how naive your solutions are.

Anonymous said...

If an EMR start-up company built a system from the ground up, using real, live doctors and nurses from every hospital area plus respiratory techs, radiology techs, pharmacists, et al. in a city with a number of large hospitals to help design the user interface, data entry, H&P,reports, error messages, it might be possible to get a decent system that would be easy to use and well accepted. Then Cerner would come along, buy it, and bury it.

Scot M Silverstein MD said...

If an EMR start-up company built a system from the ground up, using real, live doctors and nurses from every hospital area plus respiratory techs, radiology techs, pharmacists, et al. in a city with a number of large hospitals to help design the user interface, data entry, H&P,reports, error messages, it might be possible to get a decent system

This cannot happen under the current healthcare IT culture and ecosystem. User-centric development, that is, development of, by and for the users is not part of the designer-centric culture (cf. Kling, Social Informatics).

The IT culture needs to be transformed before IT can improve medicine (not "revolutionize" medicine.

"Revolutionizing medicine" is an IT pipe dream proffered largely by people who only see the surface of medicine, but not the "hiding in plain sight" complexity handled by clinicians that make medicine seen to flow relatively smoothly (cf. Nemeth & Cook).

-- SS

Scot M Silverstein MD said...

And by the way...many if not most hospital and industry CIO's would have no clue as to the meaning of my prior message. They don't know what they don't know. The field of business IT - and its office holders - are as blind to the social sciences as can be.

-- SS

Anonymous said...

I'm being re-trained for health IT under the HITECH program right now. I simply wanted to say that I am reading this, I'm taking notes, and furthermore I'm on my way. In no field should IT control or obstruct the flow of work processes; I firmly believe that. I think there are a lot of techs who do, and I hope as do you that these are initial issues.