Notes

Outline

Obstacles to IT in Health Care Dr. Milton Corn CPOE A Case Study

Why CPOE Medical errors kill or injure Many such errors are medication-related CPOE can reduce medication errors Therefore Install CPOE and save lives

How Much CPOE Is Out There? 30% U.S.  Hospitals report some CPOE            (many do not allow use by M.D.) Only 5% require system be used Over half report usage under 10%

Some Obstacles Research Can Not Solve CEO: We don’t make errors here M.D.: I tried CPOE; I hated it CFO: Can’t fit in this year’s budget CIO: We’ll build one in-house Pharmacist: I already have a system Board Chair: Let the Feds pay for it Lawyer: No way; we’ll be sued

More Obstacles Research Can’t Solve Legacy siloes Lack of standards Constraints on vendors CPOE requires EMR infrastructure Not useful without decision support    and     Decision support requires integration of systems

Research Issues for CPOE Factors affecting clinician acceptance Measuring value of CPOE for health care Exploring value of CPOE for HSR Analyzing medical errors in detail Measuring safety of computer systems CPOE as a privacy tool

Research Issues: Factors Affecting Clinician Acceptance Data entry Optimal notification methods Human-computer interface Threshold for alerts Amount of time required to use system

Research Issues: Possible Benefits of CPOE Reduce adverse drug events Alert clinician to dangerous data Improve sub-optimal practice Provide point-of-care education Decrease malpractice costs Improve hospital bottom line (ROI)

Who Will Fund The Research? NLM is major source of federal support Other Institutes may help for gene expression work Some work has been self-supported Vendors do considerable R & D