The AMDIS Connection: EHRs Just the First Step to Reform
To err is human...to provide safe, cost effective quality care; divine.
About 10 years ago, I remember hearing "To err is human" on my early morning drive to work, as a newscast covered the Institute of Medicine report reporting that tens of thousands of patients died each year due to medical errors. I thought back to the old "Mortality and Morbidity" conferences—the incorrect diagnoses, poorly chosen therapies, misread imaging studies and poor clinical decisions that arose from inexperience. What seemed so overwhelming to a lone resident in an emergent situation at 3 am was so plain in the calm light of day with the hindsight provided by hundreds of person-years of attendings' experience. I thought, "They finally caught us! They now know we are not the omnipotent experts we pretend to be!"
Over the next few days, I digested the report…legibility? Incorrect decimal places? Misunderstood abbreviations? These were not medical errors, they were plain-old mistakes. I almost breathed a sigh of relief realizing our secrets were still safe. In my na?veté, however, I also thought that if we could just get computerized physician order entry (CPOE) implemented (as we were planning), all these problems would go away and we could get on to the real business of improving medical care.
Flash forward a dozen years and several implementations later, and we are finally seeing CPOE, as well as bar-coded medication administration, clinical decision support and other initiatives on the cusp of becoming the standard of care, courtesy of the Office of the National Coordinator for Health IT and the meaningful use program. Only now, have we come to find out that the old tongue-in-cheek adage "To err is human, but to really mess things up requires a computer" may have a grain of truth.
Software brought to market too quickly, problematic implementations, lack of attention to the details of workflow and acquiescence to the way we have always done it—instead of managing the necessary change—can lead to increased errors and even patient harm. These are, however, the exceptions. As medical informatics emerges as a medical specialty in its own right, the knowledge and experience gleaned over many years enable systems to be implemented to far-reaching organizational benefit.
EHR systems are not simply better ways to store information. Medical informaticists are taking these systems to the next level by going beyond meaningful use and moving toward using EHRs in the most meaningful of ways, to improve the quality and reduce the cost of medical care. As frontline clinicians come to understand how to maximize the benefits offered and integrate them in their daily work, the landscape of medical care changes, adapting to this new tool as they did to the adoption of antibiotics, laparoscopy and cross-sectional imaging.
EHRs are a key supporting tool but not the motivating factor leading to new ways of practicing medicine. A myriad of external dynamics are compelling change in medical care. An aging population, provider shortages and healthcare reform are driving both a new care paradigm and organizational transformation. Population care can address ongoing health improvement, instead of focusing on the provision of healthcare. Clinical decision support must extend beyond alerts and reminders to presenting information in a more efficient and usable manner. And, reporting tools will leverage the delivery of medical care to provide evidence-based practice, supplementing randomized prospective research.
Regulations and finance may have driven the recent torrent of EHR implementations, but optimization both of EHRs and the way medicine is practiced is being influenced by wide-reaching societal factors. Erring may still be a human failing, but safer, more cost-effective, higher quality care is within our grasp.
About 10 years ago, I remember hearing "To err is human" on my early morning drive to work, as a newscast covered the Institute of Medicine report reporting that tens of thousands of patients died each year due to medical errors. I thought back to the old "Mortality and Morbidity" conferences—the incorrect diagnoses, poorly chosen therapies, misread imaging studies and poor clinical decisions that arose from inexperience. What seemed so overwhelming to a lone resident in an emergent situation at 3 am was so plain in the calm light of day with the hindsight provided by hundreds of person-years of attendings' experience. I thought, "They finally caught us! They now know we are not the omnipotent experts we pretend to be!"
Over the next few days, I digested the report…legibility? Incorrect decimal places? Misunderstood abbreviations? These were not medical errors, they were plain-old mistakes. I almost breathed a sigh of relief realizing our secrets were still safe. In my na?veté, however, I also thought that if we could just get computerized physician order entry (CPOE) implemented (as we were planning), all these problems would go away and we could get on to the real business of improving medical care.
Flash forward a dozen years and several implementations later, and we are finally seeing CPOE, as well as bar-coded medication administration, clinical decision support and other initiatives on the cusp of becoming the standard of care, courtesy of the Office of the National Coordinator for Health IT and the meaningful use program. Only now, have we come to find out that the old tongue-in-cheek adage "To err is human, but to really mess things up requires a computer" may have a grain of truth.
Software brought to market too quickly, problematic implementations, lack of attention to the details of workflow and acquiescence to the way we have always done it—instead of managing the necessary change—can lead to increased errors and even patient harm. These are, however, the exceptions. As medical informatics emerges as a medical specialty in its own right, the knowledge and experience gleaned over many years enable systems to be implemented to far-reaching organizational benefit.
EHR systems are not simply better ways to store information. Medical informaticists are taking these systems to the next level by going beyond meaningful use and moving toward using EHRs in the most meaningful of ways, to improve the quality and reduce the cost of medical care. As frontline clinicians come to understand how to maximize the benefits offered and integrate them in their daily work, the landscape of medical care changes, adapting to this new tool as they did to the adoption of antibiotics, laparoscopy and cross-sectional imaging.
EHRs are a key supporting tool but not the motivating factor leading to new ways of practicing medicine. A myriad of external dynamics are compelling change in medical care. An aging population, provider shortages and healthcare reform are driving both a new care paradigm and organizational transformation. Population care can address ongoing health improvement, instead of focusing on the provision of healthcare. Clinical decision support must extend beyond alerts and reminders to presenting information in a more efficient and usable manner. And, reporting tools will leverage the delivery of medical care to provide evidence-based practice, supplementing randomized prospective research.
Regulations and finance may have driven the recent torrent of EHR implementations, but optimization both of EHRs and the way medicine is practiced is being influenced by wide-reaching societal factors. Erring may still be a human failing, but safer, more cost-effective, higher quality care is within our grasp.