This is the second posting from a very busy week, thought-wise (see my
last post).
The Institute of Medicine recently came out with the acknowledgement that the current design of CPOE systems
lacks attention to human factors and may contribute to medical error.
Finally!!!! AMIA described the concept of
e-iatrogenesis in 2007.
Those of us who have been looking at CPOE systems have, for some time, been asking why it is we take user interface tools designed for simple, casual office use and produce order entry screens that are a bewildering array of fields that require multiple tabs, or multiple-page scrolling, which, by the way, chances to scrolling of the contents of a list field if you are using the scroll button on a mouse.
When you compare implementations like that to the relative simplicity of what my friend Ann Bobb calls the "medication order sentence" you see on a paper order form, you realize why physician adoption of CPOE is somewhat reluctant.
Indeed, another set of ASHP connect posts on CPOE talks about the amount of "hand-holding" that has to be done for physicians until they get used to their CPOE system.
Interestingly, the only time I have seen anyone express interest in this problem has been at a Microsoft Healthcare User Group (MS-HUG) meeting in Redmond, and then those earnest people from Microsoft were having an awful time getting people to be interested or engaged in the subject. They had some really interesting models, and had given some real serious thought to the user-interface problems they thought needed to be solved (like maintaining context so the physician always knew which patient record was currently active, and brining forth meaningful clinical history in interesting graphic ways). Instead we have perpetuated the WIMP model (Windows, Icons, Mice and Pointers).
What if, instead, a CPOE system could let the physician start writing (well... ok... typing) their order and the software used the same kinds of auto-completion tools we now see in word to assist them in ensuring that the order as entered was complete, accurate and appropriate? Wouldn't that be better? It's not as hard as it sounds; Microsoft integrated development environments (programming language editors) have been doing this for over 10 years.
What if the CPOE system could actually evaluate the current clinical condition of the patient and propose orders based on known best practices?
I am not certain that anyone knows, or can even imagine (at the moment) what the right answer (or answers) might be, but I am certain that what we are doing right now isn't working. So, apparently, is the Institute of Medicine.
What do you think?
#Technology #Informaticists #MedicationSafety #MedicationSafetyOfficers #Informatics #PatientSafety