This week I heard a very bitter physician complaining that using an electronic medical record got between him and caring for his patients, and imposed secretarial tasks on him. Then on Tuesday we got perhaps the most negative news yet about a problematic CPOE installation at Childrens' Hospital in Pittsburgh, where after its introduction patient mortality increased. There was also news about an emergency department in Arizona pulling the plug on its EMR.
Whatever the real reasons behind the data, it's clear that simply installing an EMR or CPOE system did not have the desired impact on patient safety. My cursory assessment is that electronic records are vital in improving the healthcare delivered to patients, particularly those with chronic illnesses, over the continuum of care. But it's clear that when they're introduced to ICUs or ED, where speed is the key and care processes are not well defined, things may not be so successful. A real examination of the process absent the technology, and a massive commitment from vendors to improve the human-computer interface, is quickly needed before the movement toward CPOE and EMR is stopped by these kinds of stories. After all, it's easy for a hospitals or physician groups to decide instead to do nothing. - Matthew