Quality advocates back computer orders, despite flaws

They said studies showing problems with systems will provide valuable lessons.

By Damon Adams, AMNews staff. July 4, 2005.

Two studies in past months have raised concerns among medical leaders that computerized prescribing systems are failing to prevent many medication-related problems.

A study in the March 9 Journal of the American Medical Association found that a computerized physician order entry system facilitated 22 types of medication error risks at a Pennsylvania teaching hospital. It was followed by a May 23 Archives of Internal Medicine study that found that 27% of adverse drug events at a highly computerized VA medical center in Utah were caused by medication errors.

Many medical leaders have pointed to computerized systems as a key way to decrease medication mistakes and bolster patient safety. But the studies are a warning, physicians said, that some systems are not yet sophisticated enough to reduce errors and that more improvements are needed to make them more effective.

The computerized system "did very little to address the errors in the ordering and monitoring process. These have always been the biggest problem for adverse drug events," said Jonathan Nebeker, MD, lead author of the VA study.

Proponents of computerized medicine said the studies are reason for caution but not cause to give up on computers as significant players in preventing errors.

"We have a lot to learn about how the functional characteristics of these systems can be used for safety. But at the end of the day, we're not going to get safer health care without information technology," said Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality.