Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Panacea or Pandora’s box

09.03.2005


Penn study shows that computerized physician-order entry systems often facilitate medication errors



Health-care policymakers and administrators have championed specialty-designed software systems – including the highly-touted Computerized Physician Order Entry (CPOE) systems – as the cornerstone of improved patient safety. CPOE systems are claimed to significantly reduce medication-prescribing errors. "Our data indicate that that is often a false hope," says sociologist Ross Koppel, PhD, of the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania School of Medicine. "Good computerized physician order entry systems are, indeed, very helpful and hold great promise; but, as currently configured, there are at least two dozen ways in which CPOE systems significantly, frequently, and commonly facilitate errors – and some of those errors can be deadly."

As reported in today’s Journal of the American Medical Association, Koppel and colleagues studied the day-to-day medication-ordering patterns and interactions of housestaff working in a tertiary-care teaching hospital, which, at that time, ran a popular CPOE system. In addition to a comprehensive survey of almost 90% of the housestaff who use CPOE, the researchers also shadowed the doctors and pharmacists, as well as performed interviews with the hospital’s attending physicians, nurses, IT and pharmacy leaders, and administrators. As a result, they identified 22 discreet ways in which medication-errors were facilitated by the CPOE system they studied.


The significance of their findings, notes Koppel, is to serve as a wake-up call to those who would believe that hospital IT systems -- such as computerized physician order entry systems -- represent a simple turn-key solution to patient safety; and, in particular, the reduction of medication errors. "Although we analyzed only one older CPOE system in a single setting, our findings reflect what is happening in health-care facilities across America that have adopted CPOE systems as a key patient-safety initiative," said Koppel. "We show that CPOE systems need to be very carefully designed and implemented, as well as constantly evaluated and improved. Further, as these systems continue to be improved, designers should understand that their programs must seamlessly integrate into an institutional context of infinite complexity … one that operates 24/7, under great stress, and with a constantly-changing set of people, policies, and practices."

"As vigorously as the nation’s administration pushes for IT solutions to reduce medication errors, so, too, must they push for research support in that area – so that IT systems can be constantly tested, evaluated, and modified, as necessary," adds co-investigator Brian L. Strom, MD, MPH, Professor of Medicine at Penn and Chair of its Department of Biostatistics and Epidemiology.

Two Groups of Errors

Introduced approximately 10 to 15 years ago, computerized physician order entry systems were designed to transform paper-based prescriptions into computerized orders sent directly the hospital’s pharmacy. Since then, published studies have credited CPOE systems with reducing medication errors by as much as 81%, notes Koppel, principal investigator of this landmark study. However, while illegible handwriting may have been resolved satisfactorily by CPOE systems, other risks of medical-errors are accentuated.

After identifying 22 ways in which medication errors were facilitated by the CPOE system analyzed, Koppel and his research team grouped error types into two main categories: information errors; and human-machine interface flaws. Information errors, explains Koppel, result from fragmentation of data and information, or when there is a failure to fully integrate a hospital’s multiple computer and information systems. Examples of these errors are when a physician orders the wrong dose of a drug because the CPOE system displays pharmacy warehouse information that is misinterpreted by the physician as clinical-dosage guidelines or when warnings about antibiotics are placed in the paper chart and not seen by physicians who are using only the computerized system. Human-machine interface flaws reflect machine rules that do not correspond to work organization or usual behaviors. For example, within the CPOE system studied, up to 20 screens might be needed to view the totality of just one patient’s medications – thereby increasing the risk of selecting a wrong medication. "To be effective, a CPOE system must articulate well with the work-flow within the organization," emphasizes Koppel.

"We seem to think that we can just wrap people and organizations around the new technology, rather than make the technology responsive to the way clinicians and hospitals actually work," adds Koppel, who also teaches in Penn’s Sociology Department.

Recommendations

As CPOE systems continue to be implemented and enhanced, Koppel advises institutions and governments to diligently consider the errors caused by such systems as much as the errors prevented. Indeed, he and his colleagues suggest, among other things, that IT-assistance programs focus primarily on the organization of work in an institution, rather than on the technology itself. "Computers do some things brilliantly, and people do many things brilliantly – but substitution of technology for people is a misunderstanding of both," he says. Indeed, as the 1957 Spencer Tracy / Kathryn Hepburn comedy Desk Set illustrated so well, a blind faith in technology is always misplaced.

Koppel and his colleagues also call for an aggressive examination of the technology in use: in other words, hospitals should perform an in-depth review and analysis of the way technology is actually used by physicians and nurses, rather than on how manufacturers expect the technology to be used. In addition, the researchers recommend that continuous revisions and quality improvement be part of all medical IT programs.

Rebecca Harmon | EurekAlert!
Further information:
http://www.uphs.upenn.edu

More articles from Studies and Analyses:

nachricht The Great Unknown: Risk-Taking Behavior in Adolescents
19.01.2017 | Max-Planck-Institut für Bildungsforschung

nachricht A sudden drop in outdoor temperature increases the risk of respiratory infections
11.01.2017 | University of Gothenburg

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Traffic jam in empty space

New success for Konstanz physicists in studying the quantum vacuum

An important step towards a completely new experimental access to quantum physics has been made at University of Konstanz. The team of scientists headed by...

Im Focus: How gut bacteria can make us ill

HZI researchers decipher infection mechanisms of Yersinia and immune responses of the host

Yersiniae cause severe intestinal infections. Studies using Yersinia pseudotuberculosis as a model organism aim to elucidate the infection mechanisms of these...

Im Focus: Interfacial Superconductivity: Magnetic and superconducting order revealed simultaneously

Researchers from the University of Hamburg in Germany, in collaboration with colleagues from the University of Aarhus in Denmark, have synthesized a new superconducting material by growing a few layers of an antiferromagnetic transition-metal chalcogenide on a bismuth-based topological insulator, both being non-superconducting materials.

While superconductivity and magnetism are generally believed to be mutually exclusive, surprisingly, in this new material, superconducting correlations...

Im Focus: Studying fundamental particles in materials

Laser-driving of semimetals allows creating novel quasiparticle states within condensed matter systems and switching between different states on ultrafast time scales

Studying properties of fundamental particles in condensed matter systems is a promising approach to quantum field theory. Quasiparticles offer the opportunity...

Im Focus: Designing Architecture with Solar Building Envelopes

Among the general public, solar thermal energy is currently associated with dark blue, rectangular collectors on building roofs. Technologies are needed for aesthetically high quality architecture which offer the architect more room for manoeuvre when it comes to low- and plus-energy buildings. With the “ArKol” project, researchers at Fraunhofer ISE together with partners are currently developing two façade collectors for solar thermal energy generation, which permit a high degree of design flexibility: a strip collector for opaque façade sections and a solar thermal blind for transparent sections. The current state of the two developments will be presented at the BAU 2017 trade fair.

As part of the “ArKol – development of architecturally highly integrated façade collectors with heat pipes” project, Fraunhofer ISE together with its partners...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

Sustainable Water use in Agriculture in Eastern Europe and Central Asia

19.01.2017 | Event News

12V, 48V, high-voltage – trends in E/E automotive architecture

10.01.2017 | Event News

2nd Conference on Non-Textual Information on 10 and 11 May 2017 in Hannover

09.01.2017 | Event News

 
Latest News

Helmholtz International Fellow Award for Sarah Amalia Teichmann

20.01.2017 | Awards Funding

An innovative high-performance material: biofibers made from green lacewing silk

20.01.2017 | Materials Sciences

Ion treatments for cardiac arrhythmia — Non-invasive alternative to catheter-based surgery

20.01.2017 | Life Sciences

VideoLinks
B2B-VideoLinks
More VideoLinks >>>