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November 02, 2011

Drug Administration and IT Reconciled

Picture of pillsA few years ago there was a kerfuffle in healthcare IT. A study at the Childrens Hospital of Pittsburgh concluded that mortality rates had increased with the implementation of Computerised Physician Order Entry System (CPOE). Despite being rebutted almost immediately after publication, the study gained wide credibility. It was still being quoted without qualification by a prominent academic at a UK healthcare IT conference a couple of years ago.

The findings fly in the face of common sense, of course. Thankfully, a recent study at University Hospitals Birmingham showed that the implementation of a similar system reduced mortality rates among emergency patients by 17 percent, suggesting 16 000 deaths a year could be prevented if a similar system was implemented across England.

The Birmingham study has a crucial difference, because it concentrates on the whole system. Before implementation 1 in 5 drug administrations were missed. Simple functionality addressed this systemic problem in a potent combination of IT and human process change. An important lesson for us all.

Some clinicians disparage such approaches and complain about 'tick box medicine'. But I find tick boxes rather useful for automating routine tasks--which I am not very good at. This frees my mind to address less routine matters and to be more creative. I am not the only one to think so: read Atul Gawande's Checklist Manifesto. However, I am not suggesting they make human intervention redundant.

Changed practice with the support of IT is the way of 21C healthcare, and if that means clinicians ticking boxes to relieve them of routine, free their creativity and reduce errors, so be it.