Archives for March 9, 2005

JAMA article on CPOE

JAMA — Role of Computerized Physician Order Entry Systems in Facilitating Medication Errors, March 9, 2005, Koppel et al. 293 (10): 1197

Context Hospital computerized physician order entry (CPOE) systems are widely regarded as the technical solution to medication ordering errors, the largest identified source of preventable hospital medical error. Published studies report that CPOE reduces medication errors up to 81%. Few researchers, however, have focused on the existence or types of medication errors facilitated by CPOE.

Results We found that a widely used CPOE system facilitated 22 types of medication error risks. Examples include fragmented CPOE displays that prevent a coherent view of patients? medications, pharmacy inventory displays mistaken for dosage guidelines, ignored antibiotic renewal notices placed on paper charts rather than in the CPOE system, separation of functions that facilitate double dosing and incompatible orders, and inflexible ordering formats generating wrong orders. Three quarters of the house staff reported observing each of these error risks, indicating that they occur weekly or more often. Use of multiple qualitative and survey methods identified and quantified error risks not previously considered, offering many opportunities for error reduction.

Conclusions In this study, we found that a leading CPOE system often facilitated medication error risks, with many reported to occur frequently. As CPOE systems are implemented, clinicians and hospitals must attend to errors that these systems cause in addition to errors that they prevent.

Well, now, that seems terrific, doesn’t it? I’m not a Luddite, and believe that, in general, computerization and data pushing can make medicine safer and more efficient. However, It’s a long-term project, not “OK, here’s your system, where’s the check”?

I’m told that our parent organization has already paid an astounding sum to buy an integrated, hospital-wide EMR, which would include CPOE. (Here comes 2 more weeks of EMR ads on Google again. Oh, well). They’re rolling it out in one of the smaller hospitals in the chain, with the intent to ‘work out the bugs’ there, but I’m a big believer in bugs being everywhere.

We’re going to get very dependent on our new computer overlords, and the one thing that’s assurred is that the computers will go down, usually when the tech people are asleep / away.

Color me skeptical.

via Medpundit

Update: Symtym is thinking along the same lines (I think).