Health IT: making care better or worse? (cont)
The debate about the sharp increase in mortality reported in Pediatrics after the implementation of a computerised physician order entry system (CPOE) at the Children's Hospital in Pittsburgh. (See FHIT entry) rumbles on.
I spotted this reference to a post-publication peer review, which states:
“A more accurate summary of the findings is that there were significant problems with the implementation process for CPOE at this hospital and that the hospital simultaneously instituted other system changes that may have accounted for adverse effects.”
Compounding the criticism of the study by health IT experts and others, the hospital’s medical director and other hospital officials have also disagreed with the study's findings, according to the Wall Street Journal.
In the UK the original study was also picked up by the E-Health-Insider website. Please look at the comments after the article, which are instructive and tell us about the polarisation of opinions on healthcare IT in the UK.
Even after 15 years of implementing health care IT it never ceases to astonish me how quick people are to criticise it and how little healthcare has learned about its implementation.
Implementing information systems without first changing processes and medical practice to accommodate them and carefully monitoring the result is folly, not to say negligence. This applies doubly to processes that may already be poor.
How long will it take us to learn these lessons?
More on the on the eHealth Blog.
Comments
Seems to me people think, yes let's get a computer / new system without always thinking about what problem it's going to solve.
And new technologies bring new problems, even if they fix old ones. And both the problems and the benefits can be stuff you've not imagined.
Like mobile phones: problem - I remember them being sold as things to make you feel safe; now most street crime is about mobile phones.
benefit - nobody had any idea that texting would become big, it was a "need" that nobody had stated.
Posted by: Alasdair Macdonald | January 5, 2006 07:09 PM
Alasdair,
Now that is an interesting comment.
My most unpleasant experiences of healthcare are related to NHS staff who wanted an IT system because they wanted one.
Attempting to find out why they thought IT would be useful and help them to both justify and gain maximum benefit from such an investment usually got me into hot water. In fact, it still sometimes does!
I am a protagonist of the need to fully integrate IT into care. That needs better technology, inspired clinicians and changed mindsets!
PS What is the medical equivalent of text messaging? Then we may have a "killer app".
Posted by: Colin Jervis, Kinetic Consulting | January 5, 2006 07:28 PM
Whenever I think about this stuff, an old salesman's saying comes to mind: "better for what?" And it gives me the question I've found fascinating answering: "benefit to whom?" I feel often benefits are stated as being to an organisation or process. I think it's important to understand the benefits (if any) to the users of the technology.
Don't think there is a killer app for health IT. We'll have to find a better name for the quest though...didn't the holy grail promise everlasting life?
Posted by: Alasdair Macdonald | January 8, 2006 03:02 PM
I think there is a lack of consensus of the meaning of "benefits".
I take it to mean beneficial changes; but you are right the key question is benefits "to whom?"
Benefits may be for users, but particularly patients--after all, there has to be a focus.
It is possible that what benefits a patient, may not benefit users if it entails change or additions to their work.
Unfortunately, I have seem some pretty uninspired presentations on the benefits of NHS Connecting for Health's NPfIT from Management Consultants and others. So, it is no surprise to me that the term has acquired poor connotations and may appear more like an old-fashioned time and motions study than anything requiring creativity and innovation--which is a great shame!
Posted by: Colin Jervis, Kinetic Consulting | January 8, 2006 05:25 PM
You make some good points about implementation. I think that whenever an EMR system is implemented it brings out the best and worst of the processes you have been using.
I made a similar comment( http://www.crashutah.com/emr/administrator/2006/01/10/tense-moments-when-implementing-an-emr/ ) about the need to evaluate your entire system in order to avoid morale loss when people realize they don't know how to do simple tasks.
Posted by: John | January 12, 2006 06:10 AM
"Don't think there is a killer app for health IT." I'd have to disagree: The article in question documents just such a system: CPOE implemented without sufficient planning, user buy-in, training or operational controls. I downloaded and read the full article. The most chilling element was not the the authors' complete disavowal of responsibility for the failure, but their recommendation for other CPOE implementers: to track mortality after the system goes up.
Posted by: Martin Jensen | February 2, 2006 04:26 PM
Keep up the great work on your blog. Best wishes WaltDe
Posted by: WaltDe | September 1, 2006 10:03 AM