[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 [1]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
    lasting solution.

    "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
    information technology.

    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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