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Healthcare IT: making care better or worse?

Reposted. Original post on 10 December 2005.

Of course, computerised systems, by improving patient safety, improve outcomes. No doubt about that is there? Supporters of the National Programme for IT (NPfIT) assure us that is the case.

So we wouldn’t expect to find a drugs order entry system—one of the mainstays of the Care Records Service (CRS)—associated with increased mortality rates. But a study in the American publication “Pediatrics” found just that.

“Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System” describes a retrospective analysis of mortality in the Children's Hospital of Pittsburg for 13 months before implementation and for 5 months after it. Mortality rates increased significantly after implementation.

The study concludes this is an unexpected finding—it may have been due to delays in treatment. The study recommends that mortality rates are monitored post go-live.

Improvements do not arise by simply switching on IT systems. Inexperienced users and the rigour forced by computerised-systems may slow processes initially. Therefore, it is essential that IT-system benefits are rigourously identified, monitored and realised--many pay lip service to this, few practice it.

More discussion on this topic on the HISTalk Blog here.

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Comments

One of the issues the NHS will need to face in implementing what are essentially American healthcare systems in hospitals in Southern England, will be the cultural changes required to get the best out of these. Clinical and administrative practice is very different in the UK when compared with the American system and many healthcare practitioners in the NHS feel that they haven’t been consulted with regard to functional content and the required new working practices.

The American healthcare model is hardy a cause for celebration, millions of Americans are disenfranchised through escalating costs and litigation.

Political expediency in Britain has led to considerable mistakes in the past. Government specified multi-billion pound IT procurements and implementations have never enjoyed a record of success…

I agree with some of your comments on US systems. They tend to be focused on recording transactions rather than patient events, so their database structures are fundamentally different from the NHS model.

This is sure to result in problems in reporting activity for payment by results. In fact it already has for the Homerton Hospital in London, for instance.

However, some of what you say would apply to any major IT implementation in healthcare, no matter what its provenance.

I confess I am a supporter of a national EPR system; though, it remains to be seen whether the NPfIT will survive as a IT development project with such a broad scope. Already trusts are deciding to go their own way--and are being allowed to do so.

I wonder what the expected NAO review will say in this respect...

Thanks for the HIStalk mention, Colin. I'm pleased to have found your blog. And strangely coincidentally, I too am a big fan of Yes, having seen them in the 70s (Close to the Edge, Tales from Topographic Oceans, and Relayer tours.)

I revisited their music (along with that of Genesis and many other progressive bands both old and new) after a long lapse recently and am suitably reinvigorated and also envious that you've met them personally. At any rate, thanks once again for the link.

As a US HIT professional tasked with managing some of that ludicrous process, I am intrigued by the contrasts pointed out in these commentaries. However, having reviewed the paper in question and commented on it myself, I might suggest that there is a common denominator on both sides of the pond: A dangerous reluctance of practitioners to engage in the implementation of IT systems to improve quality of care. I would hope that this would not extend to the degree espoused by the authors in the pediatrics paper, whose suggestion to their colleagues was to count mortality statistics rather than act to prevent them.

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