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 Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)

nachricht The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft

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: Neutron star merger directly observed for the first time

University of Maryland researchers contribute to historic detection of gravitational waves and light created by event

On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...

Im Focus: Breaking: the first light from two neutron stars merging

Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.

Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....

Im Focus: Smart sensors for efficient processes

Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).

When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...

Im Focus: Cold molecules on collision course

Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.

How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...

Im Focus: Shrinking the proton again!

Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.

It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ASEAN Member States discuss the future role of renewable energy

17.10.2017 | Event News

World Health Summit 2017: International experts set the course for the future of Global Health

10.10.2017 | Event News

Climate Engineering Conference 2017 Opens in Berlin

10.10.2017 | Event News

 
Latest News

Osaka university researchers make the slipperiest surfaces adhesive

18.10.2017 | Materials Sciences

Space radiation won't stop NASA's human exploration

18.10.2017 | Physics and Astronomy

Los Alamos researchers and supercomputers help interpret the latest LIGO findings

18.10.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>