E-Prescriptions Not A Cure-All For ErrorsE-Prescriptions Not A Cure-All For Errors

Get doctors and nurses to use computers to request and administer drugs, the thinking goes, and it will cut errors by eliminating illegible handwriting and warning about dangerous interactions. A study released last week put numbers to the flip side of the equation: Such systems also can introduce new errors.

One of the biggest risks stems from asking doctors and nurses to change how they work to accommodate a computerized system, says the study published in the Journal of the American Medical Association. "The largest problem is that the system asks house staff to twist the software like a pretzel rather than the software corresponding to the way the work is done," says Ross Koppel of the University of Pennsylvania School of Medicine.

The health-care industry is in the middle of an effort to move the nation to technologies such as digitized health records and electronic drug prescribing to cut costs and errors. By studying one unidentified hospital, the University of Pennsylvania identified 22 "discrete ways" in which medication errors were facilitated by a computerized physician order-entry system in use at the hospital since 1997. The errors fell into two categories: those caused by incomplete or fragmented information and those from flaws in the interaction of people and machines, such as a computerized workflow that didn't correspond to how medical staff worked.

Since the study was completed in January 2004, the hospital has replaced the old computerized physician order-entry system with a new one from the same vendor. That solved some problems, but many remain, Koppel says. Such systems can have great benefits, the study concludes, but they must be "integrated and monitored constantly."

Yet the benefits can be startling for hospitals that embrace that process. Beth Israel Deaconess Medical Center reports reducing drug errors more than 50% with an electronic-ordering system that not only checks for drug or allergy interactions but "even dose adjustment based on patient kidney function," says John Halamka, CIO of the Boston hospital's parent company, CareGroup Health System. "No manual system could provide all of this error checking."