A nice entry from Dr. Andy: Uh oh

Computerized physician order entry (CPOE) is looked on as a panacea which will decrease medical error, improve efficiemcy, and improve patient safety. Only it looks like it has some major, unintended consequences, like increasing death according to an article titled “Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System: in this months Pediatrics.

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Anyway, the findings were suprising and alarming:

Among 1942 children who were referred and admitted for specialized care during the study period, 75 died, accounting for an overall mortality rate of 3.86%. Univariate analysis revealed that mortality rate significantly increased from 2.80% (39 of 1394) before CPOE implementation to 6.57% (36 of 548) after CPOE implementation. Multivariate analysis revealed that CPOE remained independently associated with increased odds of mortality (odds ratio: 3.28; 95% confidence interval: 1.94–5.55) after adjustment for other mortality covariables.

Put in plain English, kids transported after implementation of CPOED has a more than 3 fold increased risk of death. Ouch.

(Emphasis mine). Ouch, indeed.

My response is in the comments of Dr. Andy’s post.

The American Board of Emergency Medicine (ABEM) is the Board Certifying organization in Emergency Medicine for those who are residency trained, which is the current standard for Emergency Physicians. Therefore, the ABEM is Important, and is charged with initial and recurrent certification of EM docs.

In the good old days, a residency grad would get Board Certified initially, then retest every ten years (and most specialty boards still do that). ABEM is one of the first to embrace Lifelong Learning and Skills Assessment (LLSA), which in the current iteration means reading several articles and then taking an online, open book test. Not scary, and probably a good idea (the articles chosen so far are pretty good, though the timing of the Nesiritide article could have been better).

So, it’s been in place for nearly two years. How’s it going? Here’s how:

Well. Not good. Not good at all.

Yes, diplomates can wait 8 years and take all the tests at once (which is against the spirit of the arrangement but still legal), and that’s stupid, frankly. I have no idea why the numbers are this low, and I guarantee 80% of the currently board certified docs aren’t intending to just give up their board certification at the end of their 10 years.

My personal opinion is that the horrible completion rates are a mixture of lazyness and hope (and that’s just a guess, I have no independent polling). Lazy so they don’t have to read the articles assigned and figure out how to get to the site, pay the money and take the test, and hope that if enough diplomates don’t play the Board will be forced to rescind the whole system. I think that’s dreaming and isn’t going to happen.

I also predict that my current study manuals will find some very receptive buyers in about 6 years, as the dawn occurs to a lot of EP’s.

For the record, I passed 2004 and have registered for the 2005 test, but haven’t finished it.
Update: I finished it.