UPI picks up on pitfalls of bad clinical computing

By ASTARA MARCH (covers healthcare technology for UPI)

WASHINGTON, Dec. 12 (UPI) — Patient deaths at the University of Pittsburgh Children’s Hospital blamed on a computerized physician order entry (CPOE) system point to the troubling possibility that electronic healthcare systems designed to save lives are, in some cases, having the opposite effect.

A key to correcting the problem might be to better tailor software systems to existing hospital networks and to assure that the systems are designed and implemented by specialists, experts say.

According to an article published in the December issue of the Journal of Pediatrics, after the Pittsburgh hospital installed a CPOE system the mortality rate of children
admitted to the hospital after being transported from another facility increased from 2.80 to 6.57 percent.

The CPOE system installed in the hospital at the time was Cerner Corporation’s PowerOrder.

The deaths — all linked to delays in obtaining medication — were blamed on CPOE’s software-design problems and faulty implementation.

Yong Han, of the University of Michigan Medical School in Ann Arbor and lead author of the journal article, told United Press International he was especially concerned about the software aspect of the problem.

“Medical software directly impacts patient care, for better or worse, and there are no checks and balances for it right now,” said Han, who formerly worked at the Pittsburgh hospital.

“I could get together with my friends at MIT, whip up a program, put it on the market and no one could stop me,” he said. [I wrote about this issue here in 1998 or so. – ed.]

“Drugs or medical devices must go through some degree of inspection and evaluation to determine whether the manufacturer’s claims are substantiated. There’s no such process for medical-software programs at the current time, and I think there needs to be,” Han argued.

Although she declined to comment on Han’s assessment of the system, Terri Steinberg, clinical applications manager for the Alfred I. duPont Hospital for Children in Wilmington, Del., told UPI that her facility’s own experience with the software system at issue and with similar programs, has been problem-free.

“We have used the same software program as (that used at) Han’s hospital since 1999 with no difficulty,” she said.

Steinberg also stressed the importance of the human element when using the complex computer systems. “When you implement software in a medical environment, you must address your institution’s workflow process and support the people who are using the system. Human beings are the primary determinants of failure or success of any kind of software implementation,” she said.

For its part, the software’s maker pointed to what it called flaws in Han’s study. James Fackler, Cerner’s director of critical care, charged that the data was unreliable because it compared 13 months of mortality data before the CPOE system was installed with only five months of data afterwards.

“Pediatric critical care is very seasonal. In pediatric ICUs, a mortality rate of 7 percent over six months is often followed by a mortality figure of 1 to 2 percent during the next six months. I would like to see figures for the full 13 months after our system was installed to be sure the effects were due to IT problems and not the normal fluctuations hospital pediatrics units experience,” he said.

Paul Tang, incoming chair of the American Medical Informatics Association, said he thought there would be less risk with computerized healthcare systems in the future if the software were implemented by specialists.

“Anywhere along the line, from designing the system to its implementation, the process needs to be handled by medical informatics specialists. After all, you don’t let general practitioners dispense powerful chemotherapy drugs,” Tang told UPI.

Tang said serious problems can occur at three places in a software system.

“If the software needs too many clicks or takes too long to accomplish a task, that has to be corrected. Then there’s software configuration. The vendor and the customer have to integrate the software with the hospital’s system so they work well together,” he said.

“The third place problems can occur is training staff and physicians to use the system. That’s the customer’s responsibility and it’s often neglected,” Tang said