Health IT Should Accept Criticism

Opinion: Complaints of a study pointing out flaws in health IT systems are misguided. Instead of congratulating themselves on errors they have prevented, software vendors must do more to make sure errors are averted.

Software vendors are loudly criticizing a recent study showing that hospital computer systems can help physicians make mistakes while ordering medicines.

Advocates of CPOE (computerized physician order entry) complain that the study points out flaws in an old computer system at a single hospital and does not compare the errors that the system facilitates to those that it prevents.

The cheerleaders have some valid points, but mostly they need to be more willing to accept criticism than to dish it out.

Critics dismiss the study by saying that the flaws identified by the study were already recognized and have been fixed in a next-generation product.

/zimages/1/28571.gifClick here to read more about the study, which listed more than 20 ways that CPOE made medical errors more likely to happen.

But the lead investigator, Robert Koppel, could not recall a single improvement to the CPOE that occurred during his two-year study.

Even if all the glitches were eliminated, the study still has a point to make.

The main lesson is not that 22 sources of error were identified, but that vendors and administrators need to be more willing to find and fix sources of error.

"[The vendors] have to realize that its the software that has to be malleable. They have to be responsive to whats going on on the hospital floor," said Koppel.

There was also a lot of whining that the study did not compare the errors that CPOE facilitates to the ones it prevents.

Nor does the study consider other potential benefits of CPOE, like fewer unnecessary procedures or speedier medication delivery.

But Koppel, a sociologist at the University of Pennsylvania School of Medicine, is himself an advocate of CPOE.

He just thinks systems are in want of major improvements. The point is not whether or not to use CPOE, but how to use CPOE most effectively.

The necessary improvements actually seem relatively straightforward: like not forcing physicians to work through up to 20 screens to place an order, redesigning selection screens so that its not so easy to mix up patients and medications with similar names, and increasing integration so that a doctor can see all of a patients medications.

To improve CPOE systems, vendors need to know whats not working.

To better use CPOE, hospital managers need to know what can go wrong. Koppels study, as well as those of other researchers, meets this need.

These efforts should be welcomed, not censured.

Next comes the complaint that Koppels study was conducted at just one hospital, which has now updated its computer system.

But the problems that Koppel found have been reported across many facilities. (Indeed, another complaint of vendors was that the study found no surprises.)

Next Page: The source of the errors.