It is not available free, but the questions I want to raise are valid just from the abstract available free at the above link:
Abstract
Objective To evaluate the incidence of duplicate medication orders before and after computerized provider order entry (CPOE) with clinical decision support (CDS) implementation and identify contributing factors.
Design CPOE with duplicate medication order alerts was implemented in a 400-bed Northeastern US community tertiary care teaching hospital. In a pre-implementation post-implementation design, trained nurses used chart review, computer-generated reports of medication orders, provider alerts, and staff reports to identify medication errors in two intensive care units (ICUs).
Measurement Medication error data were adjudicated by a physician and a human factors engineer for error stage and type. A qualitative analysis of duplicate medication ordering errors was performed to identify contributing factors.
Results Data were collected for 4147 patient-days pre-implementation and 4013 patient-days post-implementation. Duplicate medication ordering errors increased after CPOE implementation (pre: 48 errors, 2.6% total; post: 167 errors, 8.1% total; p<0.0001). Most post-implementation duplicate orders were either for the identical order or the same medication. Contributing factors included: (1) provider ordering practices and computer availability, for example, two orders placed within minutes by different providers on rounds; (2) communication and hand-offs, for example, duplicate orders around shift change; (3) CDS and medication database design, for example confusing alert content, high false-positive alert rate, and CDS algorithms missing true duplicates; (4) CPOE data display, for example, difficulty reviewing existing orders; and (5) local CDS design, for example, medications in order sets defaulted as ordered.
Conclusions Duplicate medication order errors increased with CPOE and CDS implementation. Many work system factors, including the CPOE, CDS, and medication database design, contributed to their occurrence.
Duplicate orders can result in over-medication, failure to discontinue, or other medication errors if not caught. They by definition increase risk.
The questions are simple:
Considering that this was a "Northeastern US community tertiary care teaching hospital", not a small hospital in a remote town somewhere lacking in HIT experience, and that "duplicate medication order errors increased with CPOE and CDS implementation", is CPOE:
- A safe technology, in a practical sense in the complex clinical setting (with complexities that are 'Hiding in Plain Sight'), in 2011?
- A technology ready for sanction-enforced national rollout?
I leave it to the reader to decide.
-- SS
Oh Scott, this is just one obviously poorly run hospital at a single point in time. So this is a second cousin to the negative anecdotes you focus on all the time. Our leaders have told us that this technology will make care cheaper and better so even if these findings were true before, I'm sure that fixes have been applied and things are way better now and we are well on our way to the future you resist.
ReplyDeleteBecause you always focus on the negatives, it is pretty clear that you are looking to derail this effort and lots of folks need the cheaper and safer healthcare it will provide.
Why dont you mention your conflict of interest to keep your fabulous MD income up and provide job security for yourself? What do you have to hide?!?! I'm sure you know that doing all these needless studies would build a real market for you! Who needs us to pay to figure out what we already know -- HIT is a home run!
Just like those bad old S&P folks, I have written to the justice department suggesting they look into your contribution to damaging the health and livlihood of patients by resisting technology.
NOT a revelation.
ReplyDeleteThis has been known for years but has been covered up by the vendors, the hospitals (with do not disclose clauses in contracts), HIT vendor trade group HIM$$, and certifier and former HIM$$ subsidiary C$HIT.
Tell me that this is not an illegal experiment.
Tell me that none of these errors resulted in injury to the guinea pig patient.
The author from Geisinger partakes in national committees with a stance that HIT is safe and efficacious. The errors reported here have been known for years by everyone who uses these unsafe devices.
ReplyDeleteWhy is he publishing now what was known for years?
Would Congress have approved spending $ billions on these dangerous devices had they been informed of the facts?
Anonymous at August 19, 2011 5:48:00 AM EDT writes:
ReplyDeleteTell me that this is not an illegal experiment.
"I will MAKE it legal" - Darth Sidious
-- SS
This hospital reports a more than three fold increase in errors of just one type, medication duplication. Known for years, why are they reporting it now?
ReplyDeleteIt is not just a "Northeastern US community tertiary care teaching hospital", not a small hospital in a remote town ...
This is Geisinger, the model hospital of modern care as repeatedly cited by Obama . It uses Epic CPOE.
The CPOE device is repeatedly cited by Obama to improve safety and reduce errors. Really??
Dripping with Sarcasm at August 19, 2011 12:27:00 AM EDT wrote:
ReplyDeleteJust like those bad old S&P folks, I have written to the justice department suggesting they look into your contribution to damaging the health and livlihood of patients by resisting technology.
Great parody!
Listen, do me a favor, next time your write the DOJ about how Healthcare Renewal damages the health and livelihood of patients by exposing all those honest-but-misunderstood healthcare executive malfeasants, PLEASE learn how to spell my name correctly.
Thank you.
-- SS
Duplicate medication and test orders are reaching the patient.
ReplyDeleteThis is a dark and dirty secret kept from the ONC (or ONC leaders Brailer, Blumenthal, and that ilk
knew and just did/do not care);
kept from lawmakers (or they knew but just liked the campaign contributions coming in from the big box HIT vendors and HIM$$);
and kept from the POTUS (or he knew, but his friendship with his personal HIT advisor and All$cript$ CEO Glen Tulman overcame the significance of such trivial daily errors that could kill patients).
From 2009 BusinessWeek article http://www.businessweek.com/magazine/content/09_18/b4129030606214_page_4.htm, straight from Geisinger's chief health information officer:
ReplyDelete"To resolve its problem, Geisinger spent an additional $2 million on fixes that took 18 months, according to Dr. James M. Walker, the hospital chain's chief health information officer. An internist and former minister, Walker is one of health technology's best-known advocates. Tech boosters frequently cite Geisinger as an illustration of IT's sunny future. But Walker concedes that the stimulus-fueled rush to adopt existing technology could cause other providers to suffer through expensive fixes with potentially harmful consequences for patients. Vendors such as Epic, Walker says, sell relatively rudimentary electronic tools and expect hospitals and doctors to assure accuracy and safety. "This can be very tricky," Walker adds. "A lot of us are trying to say: 'Look, let's slow down.' "
Walker is a health IT *advocate*. But even HE acknowledges that this is all being rushed...
ut Walker concedes that the stimulus-fueled rush to adopt existing technology could cause other providers to suffer through expensive fixes with potentially harmful consequences for patients. Vendors such as Epic, Walker says, sell relatively rudimentary electronic tools and expect hospitals and doctors to assure accuracy and safety. "This can be very tricky," Walker adds. "A lot of us are trying to say: 'Look, let's slow down.' "
ReplyDeleteUnfortunately, not enough of "us" (medical informatics specialists) are saying it - slow down - and those that are saying it have little authority.
-- SS