Going back is not an option, even though a gathering of about 150 physician true believers in the use of computer technology to improve clinical care gave sobering recognition to a growing body of published reports that clinical information technology systems can trigger their own brand of medical errors while not always saving providers time or money.
The 16th Annual Physician-Computer Connection Symposium of the Association of Medical Directors of Information Systems opened Wednesday at the Ojai Valley (Calif.) Inn & Spa beneath the Topa Topa Mountains about 85 miles north of Los Angeles.
The conference will run through Friday.
William Galanter, medical director of clinical information systems at University of Illinois Medical Center at Chicago, during a question-and-answer session Wednesday, described the change in 1999 from a 17-year-old computerized physician-order entry system by TDS Healthcare Systems Corp. to a new system being developed jointly with Cerner Corp.
Galanter said his hospital upgraded from the early version of a CPOE without giving a second thought to going back to paper-based record-keeping, even in transition, and even if it meant helping a vendor develop a new system.
"No question," Galanter said. "We were the alpha site for our vendor because we didn't want to go back to paper."
Still, there are the new realities of healthcare computerization, said William Bria, chairman of AMDIS and chief medical information officer at Shriners Hospitals for Children System, based in Tampa, Fla.
"It's not just continued evolution," Bria said. "I think we're starting to see a backlash. The good news is, it's being disseminated, the EHR. The bad news is with the pressures of time physicians are being affected by the interruptions of clinical-decision support. They're being impacted by the time it takes to not only learn but use these systems in clinical care."
Another problem, acknowledged by Bria and several other speakers throughout the opening day, was that a number of recent, well-publicized studies have reported on either a sketchy relationship between clinical IT adoption and improved patient care, or a negative relationship, where patient care was worse. In addition, there are reports that computer use can cause its own kind of errors, a phenomenon that now has its own catch phrase, "e-iatrogenesis."
"Even the fact that that term has been coined is evidence that the medical profession is looking at technology with a bit of concern," Bria said. "It presents us another challenge to identify best practices, to put healthcare IT into workflow and identify harm to patients."
Further, Bria said just as the Michael Moore documentary "Sicko" is drawing attention to the problems of the health insurance industry, healthcare IT could have its own nightmare movie. Bria called it "Clicko." "We have our own version of an expose starting to shape up," Bria said.
It will do more harm than good to merely cheerlead for healthcare IT and not speak candidly about the problems encountered in system implementations, Bria said.
"If in this kind of meeting, if we're not open about what isn't working, we shouldn't be doing it," Bria said. "This is not an implementation strategy. It's like raising children. You don't just have a birth. This is a lifetime of care for these systems."
One recent article Bria mentioned was published this month in the Archives of Internal Medicine on electronic health record use in ambulatory care that concluded "EHR use was generally not associated with improved quality of ambulatory care."
"Everybody that's been doing (IT advocacy) in any hospital across the country has been shown 500 copies of that article," Bria said. "They're saying, 'See, see.' "
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