Unintended consequences of Health IT

The Obama administration is banking on the idea that electronic medical records and related computer IT improvements will reduce errors, duplicated services and ultimately the cost of care.

But there could be some unanticipated problems at least in the area of computerized medication orders, according to a study by researchers at the University of Pennsylvania School of Medicine. The Penn researchers compared the difference between two groups of doctors in their use of two drugs with potentially dangerous interactions at the Hospital of the University of Pennsylvania and Penn Presbyterian Medical Center over a nine month period in 2006 and 2007.

Brian L. Strom

The blood thinner warfarin and the antibiotic trimethoprim-sulfamethoxazole have potentially life-threatening interactions (they increase the likelihood of excessive bleeding) So Penn’s hospitals have pharmacists call doctors when the two drugs are prescribed together for hospitalized patients. To test whether adding a hard-to-override alert in its electronic prescribing system would reduce the use of the drugs in concert, the researchers programmed the system to stop the prescriptions for half of the resident doctors and nurse practitioners while leaving the old system in place for the others.

The computerized “stops” had the desired effect; significantly fewer prescriptions of both drugs together were made by the doctors assigned to the computer intervention group. But the study was stopped early because of four cases in which there were unacceptably long delays in getting the needed drugs for patients.

Brian L. Strom, director of Penn’s Center for Clinical Epidemiology and Biostatistics, who led the study, said that a potential way to solve the problem would be to make it easier to override the computer stops in patients with HIV and other conditions for which timely administration the two medications are critical.

The study was published Tuesday in the Archives of Internal Medicine.

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