Lean thinkers and TPS advocates sometimes get a bad rap as being Luddites. That’s not true, I’d say it’s more that Lean thinkers have a healthy skepticism toward technology being a “silver bullet.” You typically need good process in addition to technology… and you need the right technology that serves your processes and your people (to quote The Toyota Way- Principle #8).
In recent years, we’ve all heard a lot about the promise of information technology from both sides of the political aisle (Obama and Gingrich). There’s been lots of hype, but will the technology like CPOE - Computerized Physician Order Entry – live up to their promise of preventing errors and preventing medical harm and death? A new study says it might not…
The well-regarded patient safety organization, the Leapfrog Group has a new report out, says this release: “Leapfrog Announces New Report on the Safety of Electronic Prescribing in Hospitals.”
From their website summary of the report:
Health information technology could inadvertently result in harm to patients without proper monitoring, according to a new report issued today by The Leapfrog Group, an employer-backed health advocacy organization.
The report calls on federal officials to act quickly by building oversight requirements into health care IT regulations now being hammered out in Washington. The report also recommends actions that hospitals and CPOE technology companies should take to assure the quality and safety of these systems.
So there’s the ‘it’s not a silver bullet’ warning.
Using a web-based simulation tool, 214 hospitals tested their computerized provider order entry (CPOE) systems for their ability to catch common medication errors, including errors that could lead to fatalities. The CPOE systems on average missed one-half of the routine medication orders and a third of the potentially fatal orders. Nearly all of the hospitals improved their performance after adjusting their systems and protocols and running the simulation a second time. The simulations were conducted from June 2008 to January 2010.
“Although this is a simulation using fictitious patients and medication orders, it should be a red flag for every hospital and information technology company in America,” said Leapfrog CEO Leah Binder. “The belief that simply buying and installing health information technology will automatically lead to safer and better care is a myth. Hospitals and vendors must continue to work together over time to ensure the effectiveness and efficiency of CPOE,” Binder noted.
Yes, you need good systems and protocols. Not just technology. No surprise to the Lean world.
If you are worried, as a patient – only 26% of hospitals have implemented these systems. I’m not saying we should avoid these systems. We just need to implement them correctly – with a process focus, making sure people are properly trained etc. The U.S. lags the rest of the Western world in CPOE adoption.
When it works, there are benefits (if you believe the Wikipedia page, my lazy reference):
Computerized physician order entry (CPOE) has been estimated to reduce the medication error rate by 80%, and by 55% for errors with serious potential patient harm, and other studies have also suggested benefits.
So, yes, this technology CAN help. There are studies that says CPOE reduces mortality, yet there are studies that suggest otherwise or, like this Leapfrog report, suggest caution is needed.
What’s your experience, in your hospital? If you’re reading this from a patient perspective, what are your thoughts?
Maybe we can all get these Coors Light (“The Silver Bullet”) style mouse pads made like this…
About LeanBlog.org: Mark Graban is a consultant, author, and speaker in the “lean healthcare” methodology. Mark is author of the Shingo Award-winning books Lean Hospitals and Healthcare Kaizen, as well as the new Executive Guide to Healthcare Kaizen. Mark is also the Chief Improvement Officer for the technology company KaiNexus.