Study Reflects Increasing Awareness
Though CPOE has been endorsed by high-profile groups like the Leapfrog Group, only about one in twenty U.S. hospitals have a system in place. Of those, fewer than half of physicians use the system for the majority of medication orders, according to information posted on the TEPR 2005 (Toward an Electronic Patient Record) Web site. Koppel said that vendors needed to be willing to investigate how their products were working in hospitals and to make "constant tweaks" to adjust the software to the clinicians, rather than the other way around. "Installing the software and teaching people how to use it is only the first of many, many steps.""With the evolution of technology since the first-generation CPOE-based systems were developed, Eclipsys has incorporated numerous features into the design and build of its Sunrise Clinical Manager that dramatically reduce the potential for human errors." Other vendors contacted by eWEEK.com were not immediately available for comment or said they could not comment because their system had not been evaluated. Two clinical informaticians contracted by eWEEK.com said the problems cited in Koppels study seemed universal. To read Monya Bakers opinion about the promises and dangers of health IT, click here. "Physicians and nurses have been concerned about the new [kinds of] mistakes for a long time, and its great to see someone documenting on that," said Russ Cucina, a practicing physician and professor at University of California, San Francisco. Joan Ash, a professor of medical informatics and clinical epidemiology at Oregon Health and Science University, has studied unintended consequences of CPOE in three different countries, and told eWEEK.com her research has come to many of the same conclusions. She said part of the problem was lack of awareness by those that pick the systems. Hospitals tend to get information from vendors and to hire consultants more inclined to study technical specifications than how a technology would fit into an organization. The study reflected an increasing and welcome consideration of how new tools work within health care organizations, she said. "I dont think anyone should be depressed by these results. I think its a wake up call, and a really good thing." Cucina said that user interfaces for clinical systems have lagged far behind those of other commercial applications partly because the clinicians using the system were not the ones purchasing the systems, but also because of the hectic, unpredictable pace of a clinicians work. "The software is written from an engineering mentality where work is linear and uninterrrupted," Cucina said, "but clinicians dont have linear, uninterrupted time." Check out eWEEK.coms for the latest news, views and analysis of technologys impact on health care.
Koppels study looked at an older CPOE system (Eclipsyss TDS) in one hospital, the University of Pennsylvania Health System. Rick Mansour, Eclipsyss Chief Medical Information Officer, said the company had already corrected flaws pointed out by the study in their latest product.