This order entry screen, from a production system (of a vendor whose stock price has recently taken a dive) shows the following. In all fairness, I do note it's unclear if the vendor or the customer's configuration "experts" were responsible for this:
CAUTION: Potential look-Alike or Sound-Alike medication - this product is COUMADIN
Below and not indented as is the selection, where the clinician is liable not to look very carefully, is the helpful interpretation: "warfarin (COUMADIN) Tablet 2 milligram Oral daily for 1 Times."
"Oral daily for 1 Times?"
To order this drug for (true) daily administration, a user must find a "repeat" icon and click the number of days the drug is to be administered. The "repeat" icon is not readily apparent amidst screen clutter.
For other drugs, the order choices are "## mg oral daily" or similar.
This semantic and human-computer interaction ineptitude is truly a disaster waiting to happen, especially with the medical/nursing/trainee staff turnaround that goes on in hospitals, and with the reality that clinicians are working at various hospitals with different CPOE/EHR systems.
Is this some sort scheme to prevent endless-administration Coumadin errors when the drug is actually deliberately discontinued, I ask? If so, it's ill-conceived and dangerous at best.
By way of further information, this drug is a common anticoagulant whose use is often protective of injurious or fatal blood clots that can cause strokes or death in people with common conditions such as atrial fibrillation or prosthetic heart valves:
Warfarin is used to decrease the tendency for thrombosis or as secondary prophylaxis (prevention of further episodes) in those individuals that have already formed a blood clot (thrombus). Warfarin treatment can help prevent formation of future blood clots and help reduce the risk of embolism (migration of a thrombus to a spot where it blocks blood supply to a vital organ).
The type of anticoagulation (clot formation inhibition) for which warfarin is best suited, is that in areas of slowly-running blood, such as in veins and the pooled blood behind artificial and natural valves, and pooled in dysfunctional cardiac atria. Thus, common clinical indications for warfarin use are atrial fibrillation, the presence of artificial heart valves, deep venous thrombosis, and pulmonary embolism (where the embolized clots first form in veins).
This is an example of the kinds of mission hostility (other equally bizarre examples presented here) that results when amateurs attempt to play doctor.
I add that this type of "errorgenicity" is inexcusable. If patients suffer harm from this type of "feature", the net of liability needs to go further than just the clinician who was caught in a web of cybernetic clinical toxicity.
More EHR madness and another physician, a cardiologist and electrophysiologist, who also believes these should be considered medical devices.
From DrWes blog (excerpts, and emphases mine; see entire post at link below):
This week I received a medical record from a large academic medical center somewhere in the United States (the details were are unimportant) that has one of these new pioneering EMR systems manufactured by $13 billion-dollar company, Cerner Corporation ... what I saw was one of the better examples of how EMRs are contributing to misinformation and confusion when health care is delivered.
I received a copy of an internal medicine consult that was performed on a patient at this outside hospital. I have extracted the "medications" portion of the internist's note exactly as it was displayed in the note below ... Needless to say, I was terrified at what the system had listed as the patient's medications:
In this example, we see multitudes of medications listed more than once. We see drugs of similar classes (antihistamines, beta blockers) on the same list. We see warfarin, one of our most dangerous drugs dispensed, without a dose included. We see what seems to be outpatient meds listed with inpatient meds, I'm not sure. Honestly, we really have no idea what medications are actually being taken from this list. And yet this list of medications is listed by the EMR as the patient's "Active Medications."
Med list (page 1). Click to enlarge; see original post for part 2.
... What the heck have we created?
Certainly, any capable physician who cares for patients would describe this medication list as worthless.
This "med list" is similar to the list I showed at part 4 of my multi-part series on the mission hostile user experience of most commercial EHR's, from yet another system, redrawn by me in redacting the vendor ID. These lists reflect a mercantile computing person's view of a med list as an inventory of pills:
... So how will we measure problems with EMRs? It seems industry representatives would rather not address these concerns. We should ask ourselves, is anyone thinking about this?