I have had the pleasure of working on an electronic health record project... Medicine is a very difficult system to work with, not the least of which because of the strong personalities and egos involved.
I am a big support of technology solutions to problems but tech by itself usually causes more problems than it solves. System or process changes require more human changes than tech changes and that fact is often overlooked by tech-proponents. Few big tech projects work because few people can incorporate both the human and the tech in one package. (There is also a lot of poorly designed tech that really does slow things down.)
Tech Glitches Can Slow Patient Care
New Computers May Deliver Turmoil When They Arrive;
One Study Cites Death Rates
December 28, 2005
A controversial study linking an increased death rate to the installation of a new computer system at Children's Hospital of Pittsburgh reinforces growing concern that such technology, hailed as a panacea for medication errors, can slow down the delivery of care and cause unintentional harm to patients if not properly put into practice.
The study, by researchers at the hospital, was published in the current issue of the journal Pediatrics and describes multiple technology glitches after a computerized physician order entry system was installed at the hospital over a six-day period in October 2002 -- including doctors unable to preregister critically ill children and then laboring over terminals to enter medication orders and tests. Nurses were pulled away from the bedside to work on terminals, reducing the patient-to-staff ratio in critical-care units. System crashes froze terminal screens and delayed the delivery of vital medications from the pharmacy. During the 18-month study period, 75 children admitted from other facilities died. The mortality rate for that group increased to 6.57% in the first five months after the system was in place from 2.8% in the thirteen months before.
"The real lesson from this study is that there can be unintended adverse effects if hospitals don't carefully plan for and implement major clinical transformations" such as computerized physician order entry, or CPOE, they added.
Other experts say the study highlights the continuing struggle that hospitals face in training doctors, nurses and other staffers to interrupt their traditional ways of working to learn computer systems that can slow them down, requiring one or two minutes and as many as ten clicks of a mouse instead of seconds to scribble a note or to yell an order.
"These are very complex systems that completely disrupt, and hopefully improve, the work flow in a hospital," says Paul Tang, a health-information-technology expert and chief medical information officer at the Palo Alto Medical Foundation, which operates multispecialty group practices in California that use computerized physician order entry systems. "If you don't do it right, it can fail miserably and cause harm to patients."
