Friday, November 20, 2015

GP Computing Systems Seem To Not Be Delivering Quite As Well As Might Be Hoped.

There seemed to be some Australian GP Computing news this week.
First we had this:

Practice software glitches wasting GPs' time

Alice Klein | 9 November, 2015 |
Practice software problems are wasting doctors’ time and have the potential to lead to dangerous prescribing errors, research shows.
On average GPs spend two hours a week troubleshooting software issues such as frozen screens, problems with software updates, and disappearing or mismatching patient data, according to a study of 87 GPs across Australia.
If replicated nationwide, this suggests that Australia's 22,600 GPs spend a total of two million hours per year fixing IT problems.
The study found that software issues also put patients at risk, with GPs in the study reporting 90 incidents that either caused patient harm or led to a near miss event over a 19-month period.
The incidents recorded in the study included:
  • A GP prescribing double the intended dose of meloxicam because the patient's dose information was not transferred correctly during a software update.
  • A patient going into a hypoglycaemic coma and ending up in ICU after a software mismatch led their GP to mistakenly prescribe glimepiride instead of trandolapril.
  • Clomiphene being prescribed instead of clomipramine due to the prescribing software's autocomplete function.
  • A child being mistakenly prescribed chloramphenicol eye drops instead of ear drops because the two items were displayed directly next to each other on the software's drop-down menu.
Lots more here:
There was a release on the same topic here:

IT problems in general practice could be putting patient safety at risk

12 November 2015
Problems with information technology (IT) in general practice are creating risks for patient care, a study led by researchers at Macquarie University, Flinders University and the University of New South Wales has found. The TechWatch study, published in BMJ Quality and Safety, examined the effects of IT errors on patient safety in general practice
The researchers asked 87 General Practitioners (GPs) across Australia to report any IT incidents over a 19 month period between 2012-2013 that could lead to patient harm or near miss events, finding that IT issues were at fault for 90 reported incidents during this period. While some of the patient safety risks were carried over from historical paper records system, there were an array of additional disruptions in workflow and hazards for patients unique to IT.
“Our results show that IT problems can disrupt care delivery and pose risks to patient safety,” said Associate Professor Farah Magrabi from the Australian Institute of Health Innovation and the NHMRC Centre for Research Excellence in E-Health at Macquarie University.
“While IT has many benefits for clinical medicine, it can and does give rise to hazardous circumstances for patients and may disrupt the delivery of care and lead to patient harm,” she added.
Some errors that were exclusively caused by IT issues included problems with user interfaces, routine updates to software packages and drug databases, and the migration of patient records to new systems. However, the study also found that issues arose due to computer-human interactions, where errors such as selecting the incorrect drug on a drop-down menu, ordering medications for the wrong patient after being distracted during the electronic ordering process, ease of access to structured notes on the electronic system causing GPs not to check other records that may not be as readily accessible, and failure to use the latest protocols were also apparent.
“At present clinical software in Australia is not built to any common safety standard and there is no systematic operational oversight of software that is used in care provision,” explained co-author Professor Michael Kidd from Flinders University.
“This leaves patient care susceptible to IT problems which could potentially be reduced by monitoring IT-related harm currently experienced by our health system,” he added.
The authors recommend surveillance of these hazards around times when clinics are migrating historical records to new systems and software updates are occurring.
“It’s important that we treat the clinical safety of e-health seriously, particularly in situations where errors are more likely to occur and harm patients,” concluded Associate Professor Magrabi.
Magrabi, Farah; Liaw, Siaw T; Arachi, Diana; Runciman, William; Coiera, Enrico; Kidd, Michael R. Identifying patient safety problems associated with information technology in general practice: an analysis of incident reports. BMJ Quality and Safety. November 2015.
The release is here:
We also had this in software rather overdoing the automation of form filling and financial claiming!

Computer says 'yes’ to CDM care plan for the nearly dead

Serkan Ozturk | 12 November, 2015 |
Concern over use and abuse of care plan items has been a long-running and heated topic of discussion among GPs.  
This year, the Professional Services Review raised the issue of computer-generated templates — seen by most doctors as a way of dealing with the red tape headaches inherent in the Medicare system. 
A regular problem, according to the PSR, is that practice software automatically updates chronic disease management (CDM) care plans, by simply changing the date.
The computer is set to remind the practice to produce new MBS care plans as soon as the patient becomes eligible.  
But some of these templates are so automated that they verge on the ridiculous.
In an interview with Australian Doctor last week PSR director Dr Bill Coote gave one bizarre example.
 “It was the preparation of [chronic disease management] items for a patient with disseminated cancer who was near death,” he said. 
More here:
I am very interested in comments on both these areas and what changes to the software readers see as reasonable to solve these apparent problems and if the issues raised are in fact real problems.

1 comment:

Bruce Farnell said...

Unfortunately, from what I have observed in General Practice IT over the past 15 years, all of the issues mentioned are very real.

I would have thought that 2 hours of lost productivity per GP per week was somewhat high. However, some lost productivity is unavoidable. All we can do is try to minimise it with the resources at our disposal.

If improved patient safety and improved patient outcomes were the true aim of eHealth in Australia then many of the issues mentioned could be addressed. The patient safety issues need to be addressed as a matter of priority.