Should hospitals study mortality rates before and after a major IT installation?
The Daily Examiner, which is one of the oldest newspapers in Australia, reports on the controversial installation of a Cerner-based hospital system in New South Wales.
It’s not clear whether the controversy is because the IT is making the lives of doctors more difficult – and therefore potentially dangerous for patients – or whether clinicians are critical of a system that, given time, could make their working lives more productive and improve outcomes for patients.
Cerner is one of two software products that are at the heart of the NPfIT, the other being iSoft’s Lorenzo.
In New South Wales the 151 year-old Daily Examiner reports that an electronic medical records system is frustrating doctors more than six months after its installation.
The article also quotes a US study which said there had been increased paediatric mortality in one emergency department after installation of a Computerised Physicians Order Entry [CPOE] system.
The study, “Unexpected Increased Mortality After Implementation of aCommercially Sold Computerised Physicians Order Entry system”, wascarried out by eight doctors who investigated the go-live in 2002 of aCPOE system at the Children’s Hospital Pittsburgh in 2002. The CPOE installation was based on Cerner software.
Helping to carry outthe study was the Universityof Pittsburgh which has become a particularly enthusiastic user ofCerner .
In last week’s article in the Daily Examiner, thechairman of a local hospital’s medical staff, Dr Allan Tyson, suggestedthat it took four times longer to properly record patient records in theCerner system than writing it down using paper.
There are othercriticisms of the system by an unnamed doctor.
Commentson the article are mixed.
The first comment is highly criticalof the US study that found increased mortality after the implementationof the CPOE system at the Children’s Hospital, Pittsburgh.
Anothercommentator is critical of the New South Wales Government’s North CoastArea Health Service [NCAHS].
Another praises the local recordssystem, saying that, after he’d had a bad fracture, electronic noteswere available of his past treatments at different locations. Thecommentator suggested that doctors who resented the new system might nothave come to training or didn’t like being accountable for the workthey had or hadn’t done.
“Surely this system cannot be that badif it s being used elsewhere in the state and/or the world?”
Anothercommentator, who was a doctor working in the local fracture clinic,said that there had been “weeks when I have not had access to any notesor X-ray reports” which has “considerably added to the length of timethat patients have had to wait to be seen”.
Thearticle in the Daily Examiner is useful in drawing attention to the USstudy on the unexpected increased mortality after implementation of aPhysician Order Entry System.
In England, some suppliers arehoping CPOE will take centre-stage as part of the NPfIT, should thenational programme survive the coalition government.
I hadn’tnoticed the US study when it was published in 2005 but it triggered somefascinating discussion on the complexities of installing major newsystems in hospitals.
The upshot of the discussion is thatinstalling new hospital systems is likely to be much more complicated,take longer and be more risky for patients than suppliers say.
Indeedthe discussions and papers suggest that it may take a year or more for amajor new hospital system to settle down, rather than the few daysallowed for in some supplier-led implementations.
While thesystem is settling down, patients may be in danger.
That said, it’s easy to see how CPOE would reduce potentially serious and even fatal medical errors when it’s properly installed, tested and used, and when it’s fully supported by clinicians.
Some doctors criticise the USstudy but there seems to be, in general, support for the idea ofstudying mortality before and after a hospital-wide IT installation.
Toblame the supplier’s system, though, may be over-simplifying things: ifyou bought a new hammer that caused injury would you blame the hammer,unless it were faulty?
I’ll cover in a separate blog post thepoints that struck me as some of the most pertinent from the papers anddiscussions.
The conclusion of US study UnexpectedIncreased Mortality After Implementation of a Commercially SoldComputerised Physicians Order Entry system:
“We have observed anunexpected increase in mortality coincident with CPOE implementation.
“AlthoughCPOE technology holds great promise as a tool to reduce human errorduring health care delivery, our unanticipated finding suggests thatwhen implementing CPOE systems, institutions should continue to evaluatemortality effects, in addition to medication error rates, for childrenwho are dependent on time-sensitive therapies.”
Doctorsblast data system – Daily Examiner, Australia
DoesCerner kill children? I don’t think so – HIStalk.
“UnexpectedIncreased Mortality After Implementation of a Commercially SoldComputerised Physicians Order Entry system” – Journal of AmericanAcademy of Pediatrics
LessonsFrom Unexpected Increased Mortality After Implementation of aCommercially Sold Computerized Physician Order Entry System -Journal of American Academy of Pediatrics
CPOE- what is it? – Wikipedia
Apaper on CPOE – Cerner website