Wednesday, July 06, 2011

Here We See The Fantasy of the DoHA / NEHTA Claims about the Benefits of the PCEHR.

A mantra that is found is a lot of the publicity around the PCEHR relates to how electronic medication management and e-prescribing (and provision of the associated information) is going get rid of all those nasty prescribing errors and save all those lives.

One in 10 electronic prescriptions contains an error: study

By Joseph Conn

Posted: June 30, 2011 - 12:00 pm ET

Electronic prescriptions are as likely as handwritten ones to contain errors, according to a study from a group of Boston-based researchers.

The study, "Errors associated with outpatient computerized prescribing systems," is published online in the Journal of the American Medical Informatics Association.

The report is based on a retrospective study of 3,850 computer-generated prescriptions received by a commercial outpatient pharmacy chain in three states in 2008. A clinician panel reviewed the prescriptions to identify and classify medication errors, potential adverse drug events (defined as those that might cause patient harm) and the rate of prescribing errors by prescription type and by system type.

The researchers found at least one error in 11.7% of the prescriptions reviewed. "About one in 10 computer-generated prescriptions included at least one error, of which a third had potential for harm," the researchers wrote. "This is consistent with the literature on manual handwritten prescription error rates."

More here:

http://www.modernhealthcare.com/article/20110630/NEWS/306309988/

A link to the abstract is in the text. Coverage is also found here:

Errors Occur in 12% of Electronic Drug Prescriptions Matching Handwritten

By Michelle Fay Cortez - Jun 30, 2011 8:30 AM ET

As many as 12 percent of the drug prescriptions sent electronically to pharmacies contain errors, a rate that matches handwritten orders for medicine from physicians, researchers said.

An analysis of 3,850 computer-generated prescriptions written over a four-week period found 452 contained errors, including 163 that could harm the patient, according to a report published today in the Journal of the American Medical Informatics Association. The rate was consistent with past studies reviewing the risk of errors when a doctor writes a prescription and hands it to the patient, the researchers said.

The results undermine the expected safety benefits from computer-generated prescriptions, said the study authors led by Karen Nanji of Massachusetts General Hospital’s anesthesia, critical care and pain department. The U.S. paid more than $158.3 million to doctors and hospitals in the first half of 2011 to encourage adoption of electronic health records, which President Barack Obama has advocated as a way to lower health- care costs and reduce medical errors.

“Providers appear to be rapidly adopting electronic health records and computerized prescribing, and one of the major anticipated benefits is expected to be through medication-error reduction,” the researchers wrote. “Many of these benefits will not be realized if the electronic prescribing applications are not mature and either do not catch or even cause new medication errors.”

More here:

http://www.bloomberg.com/news/2011-06-29/errors-occur-in-12-of-electronic-drug-prescriptions-matching-handwritten.html

Now NEHTA keeps showing this slide as justification for the PCEHR:

Impact on healthcare providers.

· Up to 18% of medical errors occur as a result of inadequate availability of patient information.

· Almost two million Australians experience an adverse drug event each year and approximately 138,000 of these end up in hospital.

· 53% of medication mistakes are considered „definitely preventable‟ and 30% of unplanned hospital admissions in those over 75 years have been associated with medication mistakes.

· Healthcare providers spend around 25% of their time collecting information rather than treating patients.

Sadly, as is shown above, the fact that while all this may be true, there is just no knowledge as to how much of this will be fixed by the PCEHR. On the basis of the reports above it is clear the solution to all these issues will be complex and multifaceted and that these sort of claims erode rather than foster confidence in e-Health.

Trying to link the proposed but unproven solution (the PCEHR) a series of problems, and suggesting the PCEHR is the panacea for all this,is just pain dishonest in my view.

David.

1 comment:

Stephen Wilson said...

It's also sobering, is it not, that the might and talent of Google hasn't been able to serve up a good PEHR solution?

http://lockstep.com.au/blog/2011/07/02/diagnosing-google-health

I suspect that the challenge of presenting meaningful clinical information to patients sans clinician, with just the right stuff being prioritised according to their condition and aptitude, is far greater than initially thought.

Cheers,
Steve Wilson
Lockstep.