printable versionComputers vital to reducing medical errors, doctor says
BY JONATHAN RABINOVITZ
David Bates
For more than a decade, David Bates, MD, has been a leading proponent of the effort to use information technology to eliminate medical mistakes that kill thousands of Americans every year. But his talk Friday at the School of Medicine carried an added note of urgency in the wake of new criticism that computerized physician order entry systems can actually increase the risk of medication errors.
"This is the backlash," Bates, professor of medicine at Harvard Medical School, said in an interview after his remarks, referring to a paper in the latest issue of the Journal of the American Medical Association.
While acknowledging that computerized physician order entry systems can introduce new problems, Bates stressed that there remain tremendous gains to be realized from such systems. "I think we can see a hundredfold reduction in the medication error rate in the inpatient setting," he said, adding the caveat that it requires carefully adopting the appropriate technology.
Bates, the latest speaker in the Center for Clinical Informatics weekly seminar series, is director of one of three federally funded Centers of Patient Safety and Research, and his work has focused on the startling realization that medical errors cause at least 98,000 deaths annually in hospitals.
Many of these mistakes are the result of adverse drug events—instances in which patients are harmed because they received the wrong drug or the wrong dose. But Bates noted that by having physicians enter prescription orders into a computer-based system instead of scribbling them out by hand, problems such as wrong dosages and patients getting the wrong medication occur much less frequently.
Referring to one of his most recent studies, Bates explained, "We counted the aggregate of all the errors before [computerizing orders] and all the errors afterward, and there was more than an 80 percent reduction."
But the JAMA article, which was published Tuesday (Bates had seen an advance copy), could lead many doctors and health-care officials to adopt a more pessimistic assessment of the benefits of such technology. According to a news release from the journal, the study evaluated the ordering system at one teaching hospital and found it facilitated 22 types of medication error risks, including pharmacy inventory displays being mistaken for dosage guidelines and inflexible ordering formats generating wrong orders.
Although the paper acknowledges that these problems can often be easily corrected, Bates expressed concern that it painted too bleak a picture of the challenges to implementing computerized physician order entry. He said that those who read the study must be aware that it focused on an institution that had a relatively old computerized ordering system as opposed to hospitals using more modern technologies that take into account the problems that the study identified.
Still, Bates and the audience of nearly 100 people, many who specialize in medical informatics, talked frankly about the need to give even more scrutiny to the problems caused by the technology as well as its successes. Capturing this reflective mood, Henry Lowe, MD, director of the Center for Clinical Informatics, asked Bates, "Do you think we're overhyping the impact of information technology on reducing medical errors?"
Bates responded that some types of safety problems, such as surgical errors, are unlikely to benefit greatly from new information technology systems and that the cost savings of eliminating errors was only a fraction of total medical costs.
But Bates' talk still held out the promise of a host of innovative solutions to safety problems—from computer-based "smart" monitoring of patients in intensive care units to automated systems to alert the right on-call doctors of new developments in their patients' conditions.
And Bates did not waiver in his belief that patients are better off when doctors stop writing prescriptions by hand. "Computerized physician order entry is the single most powerful intervention for improving medication safety to date," he said.