Errors at the speed of light

Physician Executive published a nice article entitled Errors at the speed of light this past summer. It’s a good lesson, from a Physician’s point of view (Russell Davignon), of CPOE and EMR deployments.

Russell started off talking about the existing state of the HIS:

Some older physicians were not so enthused and my partner of 25 years, who was nearing 70 when he retired in 2000, still had not learned even the fundamentals of the Meditech system we used when he passed from the practice scene. He circumvented the system and his need to learn by having the nursing staff or ward clerk print out anything he needed to see. So much for a paperless system.

Later he said:

Our physicians had become quite dependent on the electronic record for all but order writing and daily progress note functions when we began the next step of moving toward a truly total EMR in 2000.

One good lesson to learn is from the number of forms most hospitals are using. If you think you’ve “gone electronic” but only a few of the hundreds of forms you may be using are still on paper, something’s wrong:

I had naively assumed that there wasn’t much that wasn’t already electronic when I began this process but I was very wrong indeed. We counted over 800 forms that were in use somewhere in the organization that needed cataloging and bar coding to be included in the medical record.

Their organizations search for a suitable vendor went like this:

Central Vermont’s commitment to an EHR was sorely tested by the next step toward CPOE. Finding a vendor for this next portion became somewhat of a search for pixie dust.

Russell then talks about how “modular” CPOEs are not exactly that:

As in many things, this has been hampered by yet a different computer glitch. Some software programs embed their CPOE modules in other software products. Meditech is an example. Though the CPOE module can function independently, it is designed as a portion of their emergency department management (EDM) module for emergency room services. Getting nurse and physician buy-in regarding both CPOE and the EMR in the emergency room has proven to be more daunting than anticipated.

His goal remains laudible, if not difficult:

Despite the many challenges my goal remains the same: a totally paperless EMR/EHR in the next two to five years with the only paper at CVMC being the disposable drapes in the operating room.