A Step Back

From Medscape:

As hospitals have come under pressure from patients and health insurers to lower the rate of medication errors and adverse drug events, a small but growing number have purchased computerized physician order entry (CPOE) systems. These systems, credited with lowering medication errors by up to 81%, can flag harmful drug-drug interactions, eliminate mistakes due to illegible handwriting, and reduce the likelihood of errors that stem from drugs with similar names.

But instead of preventing such mistakes, a new study finds that a widely used CPOE system actually fostered 22 types of medication error risks, some of them with disturbing frequency. The study appears in the March 9 issue of JAMA.

Examples of the risks that the system allowed at the 750-bed hospital at the University of Pennsylvania Health System in Philadelphia include fragmented displays that prevented a coherent view of all of a patient's medications, pharmacy inventory displays that showed incorrect dosage guidelines, and inflexible formats that produced incorrect medication orders. In some cases, errors were reported weekly or more often.

I'm going to try to get my hands on the JAMA study, but in the meantime, here is what I wrote last month:

Everyone assumes that EMRs will drastically cut medical errors, and pretty much pay for themselves. They act like the only errors are bad orders and prescriptions due to poor physician penmenship. But you can’t ignore a very big cause of medical errors - wrong decisions by the physician. Now EMRs may have some fancy ways of picking up drug-drug interactions, but they will be silent about doctors putting patients on the wrong drugs. And EMRs bring new errors themselves - data entry. Now I’m not saying that medical errors will increase with EMRs, or even that they won’t decrease. But the decrease may not be as drastic as some claim, and it is prudent to be conservative in estimating before dropping many a dime on these systems.

I'll reiterate, I'm in no way against medical information technology. But because of the fact we don't have the best idea how this stuff will work out, it's best for the government to stick to other things - like baseball and porn.

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