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Panacea or Pandora's box

(Philadelphia, PA March 9) Health-care policymakers and administrators have championed specialty-designed software systems including the highly-touted Computerized Physician Order Entry (CPOE) systems as the cornerstone of improved patient safety. CPOE systems are claimed to significantly reduce medication-prescribing errors. "Our data indicate that that is often a false hope," says sociologist Ross Koppel, PhD, of the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania School of Medicine. "Good computerized physician order entry systems are, indeed, very helpful and hold great promise; but, as currently configured, there are at least two dozen ways in which CPOE systems significantly, frequently, and commonly facilitate errors and some of those errors can be deadly."

As reported in today's Journal of the American Medical Association, Koppel and colleagues studied the day-to-day medication-ordering patterns and interactions of housestaff working in a tertiary-care teaching hospital, which, at that time, ran a popular CPOE system. In addition to a comprehensive survey of almost 90% of the housestaff who use CPOE, the researchers also shadowed the doctors and pharmacists, as well as performed interviews with the hospital's attending physicians, nurses, IT and pharmacy leaders, and administrators. As a result, they identified 22 discreet ways in which medication-errors were facilitated by the CPOE system they studied.

The significance of their findings, notes Koppel, is to serve as a wake-up call to those who would believe that hospital IT systems -- such as computerized physician order entry systems -- represent a simple turn-key solution to patient safety; and, in particular, the reduction of medication errors. "Although we analyzed only one older CPOE system in a single setting, our findings reflect what is happening in health-care facilities across America that have adopted CPOE systems as a key patient
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Contact: Rebecca Harmon
rebecca.harmon@uphs.upenn.edu
215-349-5660
University of Pennsylvania School of Medicine
8-Mar-2005


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