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Health Biz: View healthcare IT as a tool

By ELLEN BECK

WASHINGTON, March 17 (UPI) -- U.S. healthcare slowly is moving toward electronic records, computerized physician-order-entry programs and automated drug-dispensing systems, trying to catch up to other industries that have fully embraced IT to create efficiencies, save money and increase quality.

Two studies released this week, however, point to the need for healthcare to remember, along the way, some of its own research tenets. Study data take time to collect and analyze, and therefore can be somewhat outdated at release, and high-tech clinical systems, just as drugs and devices, must be analyzed in real-time use for unexpected side effects.

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This process went a little awry when sociologist Ross Koppel -- of the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania in Philadelphia -- released a study on a CPOE system used in a hospital setting. The study found the system "facilitated 22 types of medication error risks" and recommended clinicians and physicians work to resolve those issues as more CPOE systems are implemented in hospitals nationwide.

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Koppel told UPI's Health Biz the quick reaction by healthcare providers and others was unexpectedly negative.

"It's remarkable the vitriol that's come out," he said. "Some of (it) is remarkable in that it's claiming that I'm attacking the whole idea of electronic health records -- which I think are a great idea."

Rather than viewing the study results and recommendations as a learning tool to use to make CPOE systems better, Koppel said, "somehow, I'm accused of trying to set back the course of IT. I happen to be somebody who strongly believes in IT."

Koppel began with a grant to study hospital-workplace stressors, but changed gears a bit when hospital doctors and other staff kept talking about the CPOE system as the cause of their stress and a source of errors. Previous research had shown CPOE was better than entering orders on paper, but there was nothing that looked at how the system worked once it was up and running in daily use.

"Few people have sought to look at the systems within the context of the total organization," he said. "They've looked at them in terms of error reduction."

CPOE, for certain, is better than paper orders, but as far as creating errors, CPOE systems need to be analyzed to see what errors they might cause on their own.

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Koppel's study included shadowing workers to monitor the system in action, and conducting focus groups on the CPOE issues and interviews with system users, including physicians, nurses and pharmacists.

"I just stood on the (hospital) floor and observed what happened when the meds came up and the nurses didn't get the medications they were told they would be getting," he said.

A survey of about 90 percent of the actual users of the system detailed all sorts of problems with the CPOE -- not occurring just once in a while or even weekly, but four to five times a day. Some errors were equipment related -- bad screen displays, for example. Others went more to problems with the CPOE integrating with other hospital systems.

Koppel said this type of research requires such hands-on observations and recognizing that "everything you fix will break something else."

He said he realized the system he investigated was an older version from 1997, and that newer CPOE technology solves some of the error problems he encountered, but again, he added, the newer technology also must be studied to find unintended consequences.

"Keep in mind this software is a tool to do better medicine," he said. "I don't know where that would be controversial, but apparently it is."

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Along with Koppel's study, this week the Centers for Disease Control and Prevention in Atlanta came out with a report to news media that found limited use of electronic medical records in hospitals and among doctors at their offices.

The Bush administration is pushing healthcare to adopt e-records and other clinical IT systems in an integrated system in 10 years. That could be overly ambitious given the scope and cost, but enough publicity -- along with some federal seed money for pilot projects aimed at setting industry-wide standards -- has gotten the ball rolling. Controversy over who is going to pay and how much such systems cost has made progress slow.

The CDC study found 31 percent of hospital emergency departments, 29 percent of outpatient departments and 17 percent of doctor offices used e-records during the study period of 2001-2003. Physicians, however, have widely adopted computerized billing systems, with more than three-fourths of offices employing such technology.

About 8 percent of physicians used CPOE systems, but younger doctors were more likely to do so than their older colleagues. About 40 percent of emergency departments used automated drug dispensing systems, along with 18 percent of outpatient departments.

CDC research author Catharine W. Burt told Health Biz this study will continue annually and the questions and answers will evolve along with the technology. The newest data represent a snapshot of what was happening in 2001-2003, and she said questions for the study had to be cleared by the Office of Management and Budget back in 1999.

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Burt said for the 2005 survey, "instead of asking what you are using, we're asking what are the components of the system."

In 2005, then, the actual percentages of hospitals, physicians and other providers using clinical IT systems likely has grown. The trendline from 2001-2003, however, is useful in determining where incentives could be used to speed the process of creating a seamless system, in which patients can take their medical records anywhere, because hospitals and physicians in California can access clinical information from St. Louis or New Jersey.

Healthcare IT has been evolving from the top down. Systems can cost millions of dollars, making them affordable only for larger hospital systems and physician group practices.

"While national adoption rates for health information technology are slowly climbing, we are seeing a widening gap between larger hospitals and physician groups and their smaller counterparts," Dr. David Brailer, national coordinator for health information technology said in a statement on Burt's study.

The studies by Koppel and Burt have common elements.

Dr. Manuel Lowenhaupt, vice president at the large consultancy Capgemini Health, told Health Biz two important points are that healthcare IT will become more widespread as physicians and hospitals find it has a positive cost-benefit ratio, and that such systems, as Koppel said, "are not magic, they are not solutions, they are tools."

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Lowenhaupt said healthcare IT has improved and more health professionals have learned to use these tools, but "the organizations that understand the need to build policy-process workflow that maps to the electronic records in an effective way are the ones that are going to get the value out of their investments."

He called Koppel's study a "nice delineation of some of the hazards of the road" and the next step is designing systems eliminate barriers preventing widespread adoption.

Physicians left paper claims behind when insurers forced them to file electronically if they wanted to get paid. The benefit definitely outweighed the cost. When healthcare IT reaches the point where physicians cannot practice without being able to use a CPOE or e-record, the cost-benefit ratio again will push them to make the investment.

"The conversations I've had (with providers) have changed tone," Lowenhaupt told Health Biz, "to not 'should we do it?' -- now it's all about sequencing, timing, appropriate prep work."

Physicians are becoming more sophisticated and younger ones in training already know how to use the technology available.

Lowenhaupt said he still gets the occasional "over my dead body" comment about healthcare IT from some physicians, "but there is a growing number of doctors who say, 'I can't imaging seeing a patient in a healthcare system that has not embraced this technology.'"

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When the entire healthcare system embraces clinical IT systems, the potential rewards will be fewer errors, lower costs and better quality care for patients.

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