[Paleopsych] NYT: Doctors' Journal Says Computing Is No Panacea
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Fri Apr 15 14:02:00 UTC 2005
Technology > Doctors' Journal Says Computing Is No Panacea
By STEVE LOHR
The Bush administration and many health experts have declared that
the nation's health care system needs to move quickly from paper
records and prescriptions into the computer age. Modern information
technology, they insist, can deliver a huge payoff: fewer medical
errors, lower costs and better care.
But research papers and an editorial published today in The Journal of
the American Medical Association cast doubt on the wisdom of betting
heavily that information technology can transform health care anytime
One paper, based on a lengthy study at a large teaching hospital,
found 22 ways that a computer system for physicians could increase the
risk of medication errors. Most of these problems, the authors said,
were created by poorly designed software that too often ignored how
doctors and nurses actually work in a hospital setting.
The likelihood of errors was increased, the paper stated, because
information on patients' medications was scattered in different places
in the computer system. To find a single patient's medications, the
researchers found, a doctor might have to browse through up to 20
screens of information.
Among the potential causes of errors they listed were patient names'
being grouped together confusingly in tiny print, drug dosages that
seem arbitrary and computer crashes.
"These systems force people to wrap themselves around the technology
like a pretzel instead of making sure the technology is responsive to
the people doing the work," said Ross J. Koppel, the principal author
of the medical journal's article on the weaknesses of computerized
systems for ordering drugs and tests. Dr. Koppel is a sociologist and
researcher at the Center for Clinical Epidemiology and Biostatistics
at the University of Pennsylvania School of Medicine.
The research focused on ways that computer systems can unintentionally
increase the risk of medical errors. The study did not try to assess
whether the risks of computer systems outweigh the benefits, like the
elimination of errors that had been caused by paper records and
Yet Dr. Koppel said he was skeptical of the belief that broad adoption
of information technology could deliver big improvements in health
care. "These computer systems hold great promise, but they also
introduce a stunning number of faults," he said. "The emperor isn't
naked, but pretty darn threadbare."
Another article in the journal looked at 100 trials of computer
systems intended to assist physicians in diagnosing and treating
patients. It found that most of the glowing assessments of those
clinical decision support systems came from technologists who often
had a hand in designing the systems.
"In fact, 'grading oneself' was the only factor that was consistently
associated with good evaluations," observed the journal's editorial on
computer technology in clinical settings, titled "Still Waiting for
The principal author of the editorial, Dr. Robert L. Wears, a
professor in the department of emergency medicine at the University of
Florida College of Medicine in Jacksonville, said the message from the
research studies was that computer systems for patient records, the
ordering of treatments and clinical decision support have not yet
shown themselves to be mature enough to be useful in most hospitals
and doctors' offices.
"These systems are as much experiments as they are solutions," said
Dr. Wears, who also holds a master's degree in computer science.
The medical journal's articles, according to some physicians and
technology experts, tend to be too broad in their criticisms because
the technology is still developing rapidly and some of the computer
systems reviewed were old.
Still, even those experts conceded that the articles raised some good
"They are absolutely right that the people who design these systems
need to be in tune with the work," said Dr. Andrew M. Wiesenthal, a
physician who oversees information technology projects at Kaiser
Permanente, the nation's largest nonprofit managed care company. "But
the newer systems are designed more that way."
Dr. David J. Brailer, the administration's national coordinator for
health information technology, termed the articles a "useful wake-up
call," though he said the findings were not surprising. In health
care, as in other industries, he said, technology alone is never a
"The way health information technology is developed, the way it is
implemented and the way it is used are what matter," Dr. Brailer said.
But Dr. Brailer did take issue with the suggestion that the Bush
administration is encouraging a headlong rush to invest in health
For the next year, he said, his policy efforts will be to try to
encourage the health industry to agree on common computer standards,
product certification and other measures that could become the
foundation for digital patient records and health computer systems.
"We're not ready yet to really accelerate investment and adoption,"
Dr. Brailer said. "We have about a year's worth of work."
Dr. David W. Bates, medical director for clinical and quality analysis
in information systems at Partners HealthCare, a nonprofit medical
group that includes Massachusetts General Hospital and Brigham and
Women's Hospital, said careful planning and realistic expectations
were essential for technology in health care.
"But the danger is if people take the view that computerized physician
order entry and other systems are a bad idea," said Dr. Bates, who is
a professor at the Harvard Medical School. "That would be throwing out
the baby with the bath water."
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