Computerized prescription order systems called 'false hope' for preventing medication errors

A sociologist at a Pennsylvania medical school says CPOE's may end up causing more problems than they solve.

"Good computerized physician order entry systems are, indeed, helpful and hold great promise; but, as currently configured, there are at least two dozen ways in which CPOE systems significantly, frequently, and commonly facilitate errors," he say.

The critic's study on the issue has been published in the American Medical Association's journal. In that report he recommends CPOE's be implemented very carefully and that healthcare managers closely monitor the systems with constant improvement in mind.

• Health-care policymakers and administrators have championed specialty-designed software systems -- including the highly-touted Computerized Physician Order Entry (CPOE) systems -- as the cornerstone of improved patient safety.
• CPOE systems are claimed to significantly reduce medication-prescribing errors.
• "Our data indicate that that is often a false hope," says sociologist Ross Koppel, PhD, of the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania School of Medicine.
• In addition to a comprehensive survey of almost 90% of the housestaff who use CPOE, the researchers also shadowed the doctors and pharmacists, as well as performed interviews with the hospital's attending physicians, nurses, IT and pharmacy leaders, and administrators.
• The significance of their findings, notes Koppel, is to serve as a wake-up call to those who would believe that hospital IT systems -- such as computerized physician order entry systems -- represent a simple turn-key solution to patient safety; and, in particular, the reduction of medication errors.
• "We show that CPOE systems need to be very carefully designed and implemented, as well as constantly evaluated and improved.
• Further, as these systems continue to be improved, designers should understand that their programs must seamlessly integrate into an institutional context of infinite complexity ...
• one that operates 24/7, under great stress, and with a constantly-changing set of people, policies, and practices."
• "We seem to think that we can just wrap people and organizations around the new technology, rather than make the technology responsive to the way clinicians and hospitals actually work," adds Koppel, who also teaches in Penn's Sociology Department.
• As CPOE systems continue to be implemented and enhanced, Koppel advises institutions and governments to diligently consider the errors caused by such systems as much as the errors prevented.