Patient information systems spawn surprising number of medical errors

Touted as a panacea for medical errors, patient care information systems such as computerized provider order entry may actually foster rather than reduce mistakes, according to two new studies.

"In the U.S., Europe, and Australia, we have seen situations in which the system of people, technologies, organizational routines, and regulations that constitute any healthcare practice seemed to be weakened rather than strengthened by the introduction of patient care information systems applications," said Joan Ash, Ph.D., of the department of medical informatics and clinical epidemiology at Oregon Health and Science University.

Some information systems are designed or implemented in ways that actually increase the likelihood of errors, she said.

Ash's study does not discuss software bugs, hardware issues, or organizational dysfunction, which can all theoretically be dealt with through testing before implementation (J Am Med Inform Assoc 2004;11(2):104-112). It focuses on latent or silent errors that can result from the mismatch between information systems and the real-life demands of healthcare.

Some systems require data entry so elaborate that the time spent recording patient data is significantly greater than it was with paper, Ash said. Worse, overly structured data entry can lead to a loss of cognitive focus by the clinician.

"When determining differential diagnosis, the act of writing the information is integral to the cognitive processing of the case," she said.

Similarly, the need to switch between different screens can result in a loss of overview, which some clinicians argue works against their ability to acquire, maintain, and refine a mental command of the case.

Another study found that a widely used computerized physician order entry system facilitated 22 types of medication error risks. Fragmented displays, for example, prevent a coherent view of patients' medications, and pharmacy inventory displays are mistaken for dosage guidelines (J Am Med Inform Assoc 2005;293(10):1197-1203).

"Published studies report that computerized order entry reduces medication errors up to 81%, but few researchers have focused on the types of medication errors these systems can facilitate," said Ross Koppel, Ph.D., of the center for clinical epidemiology and biostatistics at the University of Pennsylvania.

As computerized order entry systems are implemented, clinicians and hospitals must attend to the errors they cause, as well as the errors they prevent, he said.