Unintended consequences of clinical automation and EMRs
Posted Jun 25 2010 1:13pm
One of my favorite new blogs is healthsystemCIO.com . There is some terrific reporting and more importantly unique and value-added coversations going on between healthcare CIOs. I ran across the recent “ Dissecting Physician Resistance to CPOE ” posting and thought it was worth sharing. Timothy Hartzog, M.D., Medical Director of IT, Medical University of South Carolina said the following about how implementing Computerized Physician/Provider Order Entry has unintended consequences but all the lessons are applicable to any clinical automation. Here’s a flavor of what he said:
Implementation of clinical informatics creates emotional aspects and unintended consequences, such as the following:
More/New Work for Clinicians – work unit secretaries use to do, now requires physician time to complete
Unfavorable Workflow – hard stops in CPOE are just a bad idea and lead to angry physicians.
Never Ending Demands for System Changes – physician hate when the user interface changes too often, so have an educational plan for when changes are made.
Problems Related to Paper Persistence – many complex items like TPN, CHEMO, etc., must be ordered on paper.
Untoward Change In Communication Patterns and Practices – with CPOE, physicians can enter orders from anywhere in the hospital and the nurses never know.
Negative Emotions – when Computers do not work at stressful moments, physician get angry.
Generation of New Kinds of Errors – computers can change how meds are ordered, and confusing interfaces can lead to mistakes.
Unexpected and Unintended Changes in Institutional Power Structure - physicians have always prided themselves on being able to treat patients their way. With CPOE, physicians are forced to use certain meds and protocol restrictions.
Over-Dependence on Technology – one of my rules to all clinicans is: “IF the medication dose does not look right, it is NOT right until to prove otherwise.” Just because it is on a computer screen does not mean it is always correct.