Chapter 12: Can Information Systems Make Your Doctor Better?

1) Hospitals and physicians are facing many problems in diagnosing diseases and prescribing medications. More than 1.5 million Americans are injured each year by drug errors In hospitals, nursing homes, and doctor’s offices. More than 7,000 Americans are killed each year because of inappropriate prescriptions. A preventable drug error adds more than $5,800 to the hospital bill of a single patient, and preventable drug errors occurring in hospitals may amount to $3.5 billion annually. There are some management, organizational, and technological factors responsible for these problems. Many of these errors are the result of human factors such as poor handwriting, memory lapses, fatigue, and distractions, compounded by the sheer volume and complexity of available medications. There are more than 10,000 prescription drugs on the market and 300,000 over the counter products. Many have vastly different dosage and usage instructions depending on the patient’s age, weight, and risk factors.

2) CPOE and DDS are appropriate solutions. The CPOE tries to reduce prescription and dosage errors for medications, keep physicians updated on treatment guidelines, and prevent physicians from ordering superfluous tests or drugs that are not part of the standard formularies. The value of decision support lies in its ability to remember thousands of details and bring the right ones to the attention of doctors at the right times. Communications between doctors and nurses can run much more smoothly. The hospital staff members can avoid literally running back and forth to consult each other because the system contains all of the pertinent information. Doctors save time on their rounds by visiting patients with laptops. They can ender orders for drugs and labs, as well as view lab results, without having to return to their offices. The orders are less likely to contain errors or be misread by labs or pharmacies because they are not handwritten. Some studies have shown that CPOE systems can prevent one-fourth of all adverse drug effects. DDS will make healthcare more efficient and save money for patients and insurance companies. The system can help prevent costly malpractice cases. It can serve as a “diagnosis reminder.” There are management, technological, and organizational issues involved in the use of these systems. Physicians must be willing to incorporate the use of these systems in their workflow. CPOE systems must support sophisticated decisions, such as drug choice, dosages, and patient-monitoring strategies, and they must be well designed.

3) There are many obstacles that prevent computer systems from improving the medical industry. Doctors and nurses must trust the system. If they do not trust the system, they are more likely to ignore the automated prompts. Using decision-support software might be hard for doctors to get used to because doctors prefer to trust their experience and training. Some doctors resist the idea that they need help remembering procedures and treatments. Many physicians argue that diagnosing medical conditions is as much an art as it is a science, and DDS systems have not proved to be more successful than human diagnostics. Therefore, estimates place the percentage of doctors in the U.S. who use such systems at no higher than 2%. Doctors feel that the cost of the system is too high. They also feel that the time that it takes to input the data into the system is too much. There are things that can be done to remove these obstacles. As the technology improves and doctors become more involved in the development of DDS systems, the systems may become more desirable. As doctors learn more about the CPOE and DDS systems, they may embrace them more. Physician education is key to removing the many obstacles that these systems face.