Clinicians make mistakes; they are human like the rest of us. Because of those human mistakes, information systems are often posited as a solution to catch and correct errors. But the systems are designed, implemented and operated by humans. Kind of a conundrum. Research reported in the Archives of Internal Medicine regarding computerized physician order entry systems reflects the care needed to ensure that moving everything to the electronic world doesn’t cause problems. (Internal Med. Article)
Computerized physician order entry systems allow the placement of edits to guide the physician’s behavior and help them avoid serious errors that threaten patient safety. A prime example is ordering multiple medications that may interact with each other in harmful ways. But physicians often override these computerized edits, for a variety of reasons. The research looked at using a “hard stop” which literally prevented execution of the order in connection with the administration of blood-thinning medications.
The hard stop was very successful at preventing “inappropriate” orders but it turned out to also create serious problems for a few patients. In four cases the hard stop delayed immediately needed therapy with potentially life-threatening consequences for the patients. The study was stopped early because of this. The research shows the difficulty in having a software program capture all the intricacies of medical judgment and of finding ways to effectively mix the expertise which can be stored in software with the experience and judgment of a clinician treating a patient real time.