Doctors pull plug on paperless system

California's Cedars-Sinai turns off its computerized physician order entry system after physicians revolt, demonstrating that implementing new technology is easier said than done.

By Tyler Chin, AMNews staff. Feb. 17, 2003.

Information technology is often touted as the cure for all that ails the delivery of quality medicine, but some physicians say this cure can be worse than the disease.

Cedars-Sinai Medical Center in Los Angeles turned off its computerized physician order entry system in January, after hundreds of physicians complained that rather than speeding up and improving patient care, it actually slowed down the process of filling their orders -- assuming those orders didn't get lost in the system.

"I'm not opposed to change ... but it's got to be new and better," said Dudley Danoff, MD, a urologic surgeon who helped organize physician opposition. "This was new but certainly not better" than paper.

Cedars-Sinai's decision was extraordinary but not unique. David Classen, MD, of First Consulting Group, says he knows of at least six other hospitals that have pulled paperless systems in the face of physician resistance and other problems.

The issue, Dr. Classen said, is not necessarily one of the quality of the technology. The success of paperless order entry and electronic medical record systems has to do with how they're implemented as much as what is being used, experts say.

In Cedars-Sinai's case, the hospital believed that by working with a 40-physician medical executive committee, it had sufficiently involved physicians in the design and implementation process. But rank-and-file doctors said the committee did not represent their interests.

The Cedars-Sinai pullback "will reinforce the importance of the cultural and organizational issues in successful implementation, and in that way it will ultimately be beneficial," said Dr. Classen, vice president and head of patient safety practice at First Consulting Group. "Physicians must be the champions of this particular process in order to bring it successfully to conclusion."