American Medical News (American Medical Association)
Upgrading e-prescribing system can bump up error risk
Some of those risks can put patients in jeopardy in the first few weeks of implementation, a study finds.
By PAMELA LEWIS DOLAN, amednews staff. Posted June 13, 2011.
Switching to new or upgraded electronic-prescribing systems may pose patient safety risks during the transition period, despite the advanced clinical decision support tools offered by the newly implemented technology.
Let me translate this euphemism: "Patient safety risks" = risks that patients will be maimed or killed.
Many hospitals and physician practices are upgrading or switching their ePrescribing systems to meet meaningful use incentive requirements.
The collateral damage and/or roadkill on the way to "meaningful use" might be you or your loved one...
Physicians from Weill Cornell Medical College and New York-Presbyterian Hospital, both in New York, authored a report published online April 16 in the Journal of General Internal Medicine that identified challenges associated with switching to new e-prescribing technology. Some of those issues may pose safety threats during the first few weeks after implementation, the study found.This is accurate, if you consider three months to a year of increased medical error risk "a few weeks":
Researchers examined prescribing errors that occurred from February 2008 through August 2009 at an academic-affiliated ambulatory clinic that switched from an older electronic medical record system to a new one with advanced clinical decision support for ePrescribing. They measured errors that occurred with the old system prior to implementing the new system, 12 weeks post-implementation of the new system and errors that took place one year later.
The report showed that the largest number of errors occurred before implementation, when the old system was still in use. The number of overall errors dropped from 36% to 12% one year later. [12% = more than one in ten. Why not near zero a.k.a. six-sigma for the billions of dollars spent? - ed.]
The most common errors, those caused by improper abbreviations, fell from 24% to 6% in one year. But the number of non-abbreviation errors, such as those associated with directions, frequency and dosage mistakes [just minor "issues" - ed], increased in the first 12 weeks of implementation of the new system.
[Remember, though. Three months = "just a few weeks" - ed.]
Experimental technology-related injury and roadkill figures were apparently not included.
Now for the assumption:
Study co-author Rainu Kaushal, MD, MPH, chief of the Division of Quality and Medical Informatics at Weill Cornell Medical College, said she knew the transition from paper to electronic was difficult for most physicians. She was surprised to learn that even for experienced e-prescribers, the move to a new system can be challenging. Dr. Kaushal, who was involved in the transition studied for the report, said she found the experience to be "exceedingly difficult."
"We thought it would be more of a seamless transition because people were already accustomed to sitting in front of a computer, entering in orders and so on, so they didn't have to get used to that piece," she said.
Where do foolhardy assumptions such as "We thought it would be more of a seamless transition because people were already accustomed to sitting in front of a computer, entering in orders and so" come from?
Do these 'experts' have absolutely no engineering sense, e.g., that when you have learned to use one complex machine (virtual in the case of an EMR), using another that has many differences is not 'automagically' a piece of cake?
By that flaw in logic, a Cessna pilot should have no problems rapidly learning to fly a 747 - or the Space Shuttle.
"But each electronic system has its nuances and learning how to utilize it and optimize the physician-computer interaction takes time. Every time a switch is made there are important issues that arise."
"Important issues" is a rather kind euphemism. Let me state the same concept via a dysphemism::
I think this is a more honest way to state the nature of the "issues" here.
"Each electronic system has its nuances and learning how to utilize it and optimize the physician-computer interaction takes time. Every time a switch is made there are important clinical mistakes these changes cause clinicians to make. But mistakes never, ever, ever cause patients to be maimed or killed - at least not that we're going to admit publicly. Besides, these adverse outcomes are justified anyway, because we have the right to play God with peoples' lives through IT experimentation, using unregulated, unvetted medical devices without informed consent (link), for the greater good that will necessarily follow via technological determinism."
Also see my June 2011 post "Electronic medication prescribing: The Magic Bullet Theory of IT-Enabled Transformation once again bites the dust in the real world of medicine" for more on ePrescribing, and more on the change of health IT from clinician adviser to clinician governor. From that post:
As many as 12 percent of the drug prescriptions sent electronically to pharmacies contain errors, a rate that matches handwritten orders for medicine from physicians, researchers said.
-- SS
I was helping my wife’s aunt take her 99 year old uncle to the hospital for a minor procedure. One of my functions is to sit with both of them as they are alone for much of the time.
ReplyDeleteUpon entering the check-in area the aunt disappears to check-in at one of a number of kiosks manned by a person. I sit with the uncle until the aunt returns.
This time, while we were waiting, “the doctor is sorry, but they are running behind schedule,” a nurse shows up in the waiting area, with a faded printout or photo copy with the uncle’s medication list. They then go over this list with the nurse putting a line through certain medications and adding others to the bottom of the page.
I made a comment that I thought the new health care law would eliminate this type of thing and make it all electronic with the doctor’s office automatically updating the hospitals records. What I got was a glaring stare from the nurse.
So my questions become:
Why was this not done at the time of check-in where there would be more privacy and a quieter atmosphere?
What happens to this updated paper?
Will it be handed off to be inputted by someone else?
Will this copy be kept in a physical file?
Why is the hospital interested since no medication was given during the procedure?
What I see is a multi-step procedure with the opportunity for error increasing with every step, and things only get worse when we add multiple people to the mix.
This jumbled system, and the push for financial gain, that introduces error at every step can only produce negative results, results that Scot has dealt with first hand. It is well past time to slow this process down and look at the true human cost, both in man hours needed to make the change and safety.
Steve Lucas
I wonder why the FDA has not evaluated these devices for safety, efficacy, and usability.
ReplyDeleteBesides the vendors, their lobbyists, CMS Chief Berwick (who never used the device), Secretary Sebelius (who never used the device), who, exactly, has determined that these devices provide improved outcomes, are less costly, and do not promote new errors?
Steve Lucas wrote:
ReplyDeleteThis jumbled system, and the push for financial gain, that introduces error at every step can only produce negative results, results that Scot has dealt with first hand. It is well past time to slow this process down and look at the true human cost, both in man hours needed to make the change and safety.
What's the economic value of a 99 year old compared to a shiny new multimillion dollar CPOE system?
-- SS
Anonymous July 24, 2011 4:40:00 PM EDT wrote:
ReplyDeletewho, exactly, has determined that these devices provide improved outcomes, are less costly, and do not promote new errors?
Someone must have, somewhere, while refuting all evidence to the contrary, or else our government would not be pushing these medical devices on 300 million people.
Um...right?
-- SS
Welcome back Scot!
ReplyDelete