In patient care, technology is the future, but it is no panacea, according to a recent study conducted by Penn professors.
Sociology professor Ross Koppel's study, published in this month's Journal of the American Medical Association, found 22 situations in which a computerized physician system increased the probability of medication errors.
These results counter the belief held by many, including members of the Bush administration, that computerizing health records will reduce medical mistakes -- the cause of at least 44,000 deaths in hospitals each year, according to the Institute of Medicine -- and costs.
While the study, conducted at the Hospital of the University of Pennsylvania, uncovered the fallibility of computerized systems, the authors do not advocate a return to the prior system of pen and paper.
"Our key conclusions are not that these systems should not be used, but that these systems have flaws," said co-author Brian Strom, who is also vice dean for the University of Pennsylvania School of Medicine and vice president of the University of Pennsylvania Health System.
Past studies have cast an overwhelmingly positive light on computerized systems.
Koppel attributes this to the context in which they were studied, adding that in the desire to solve medication error, people may overlook the problems that arise when introducing technology in any environment.
"We looked at both sides of the sword," Koppel said.
Rather than solely examining the ways in which computerized order entry systems reduced errors, Koppel and his team investigated the system's role in creating errors as well as the interaction between user and the technology.
The increased probability of error arose from two sources -- "fragmentation of data" and "human-machine interface flaws," according to the study.
In one example from the study, a patient's medication information spanned 20 screens, "increasing the likelihood of selecting a wrong medication."
Koppel said he found it shocking how frequently errors were reported.
"The emperor is not naked, but some of the garments are threadbare," he said, describing the computerized physician order entry studied.
"I think hospitals have to recognize that it's a tool that offers tremendous advantages but requires an ongoing commitment to monitor and evaluate the system," Koppel said.
Hedy Cohen -- vice president of the Institute for Safe Medication Practices -- said that technology is "not the end-all-be-all" and should be considered a tool to enhance safety.
But she takes issue with the "antiquated" CPOE system studied by Koppel, pointing out that this particular system is eight to 10 years old.
"Yes, this system is old, but why did it take a decade to find these problems?" Strom asked.
The budget for the research of patient safety receives approximately $50 million annually from the federal government -- "which is absurd, given what's at stake," Strom said, adding that deaths caused by preventable medical errors exceed those caused by AIDS and breast cancer.
Koppel said he will continue to study CPOE systems in different hospitals, and Strom, as head of the Center of Excellence for Patient Safety Research and Practice, will investigate different sources of medication errors.
