Medical Technology and Patient Safety: EMR’s, COW’s, iPads, etc. – are they really doing the job? Blog Series – Part I

This post was authored by Brian Nash and posted to The Eye Opener on March 28th, 2011.

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Medical Technology - source: Siemens.com

This is the first installment of a series of posts on issues relating to new advances in medical technology and how they may affect patient health and safety – not always for the good. Unless you live in a cave or just don’t care, you must have noticed news reports about how the medical industry is awash in the creation and implementation of new technologies. Presumably these new medical tech toys and gadgets are intended to advance the timely, enhanced, cost-effective delivery of healthcare with the end point being improved patient care and patient safety. The question is – do they always do that or can they, in fact, be tools the lead to patient injuries and – at times -even death?

I recently came across a posting by Dr. William L. Roper, MPH, CEO of the University of North Carolina Health Care System, which was in essence a transcript of a speech he gave at the Agency for Healthcare Research and Quality (AHRQ) in Washington, D.C. on March 23, 2011. Among his other vast accomplishments, in the spring of 1986, he was nominated by President Reagan and confirmed by the Senate for the position of administrator of the federal Health Care Financing Administration, with responsibility for the Medicare and Medicaid programs nationally. For the previous three years, he served on the White House domestic policy staff.

I bring Dr. Roper’s recent remarks to your attention since they are the inspiration for this series of blogs. While Dr. Roper’s address did not specifically address topics such as EMR’s, COW’s (still wondering how a cow fits into this topic? Stay tuned!), and the like, the following selected excerpts are the seeds of thought for the present series:

I have the job of leading an academic medical enterprise, and am challenged by the task of putting lofty ideas into practice at the local level. I remain very committed to the effort, but we are daily challenged to put the best ideas into practice.

The Institute of Medicine, under Sam Their’s and then Ken Shine’s leadership, played a very important role across the decade of the 1990s, defining “quality” in health care, and pointing to problems in quality and patient safety. Bill Richardson led a multi-year IOM initiative that included the groundbreaking report, To Err is Human in 2000, and then Crossing the Quality Chasm in 2001.

These reports were a clarion call for action – especially making the point that a systems approach was required to deal effectively with these issues.

While Dr. Roper’s speech was, in large part, an historical analysis of progress in the Medicare healthcare delivery system, it is also a well-versed commentary on the so-called advances in medicine for patient care and safety. Why else have so many toiled for so long in trying to find system-failures and methodologies for eradicating those failures and thereby improving the delivery of safe, efficient and effective healthcare?

Dr. Roper and so many other dedicated healthcare professionals are faced daily with the same issue – “…challenged by the task of putting lofty ideas into practice at the local level . . . [W]e are daily challenged to put the best ideas into practice.” Put another way – at least for me – taking public healthcare policy and practices and making a better widget.

As these lofty concepts were debated, published and analyzed, technology streaked along with its new bells and whistles at what some might call an amazing – almost mystifying – pace. Did you really envision yourself 25 years ago sitting with your iPhone or iPad and scouring the world’s news, chatting with your friends and followers on the other side of the planet, watching the latest streaming video of March Madness or sharing every random thought you have on Twitter or Facebook?

What has technology done to improve healthcare?

The answer, in short, is – some amazing things and some not so amazing things have taken place in terms of technological advances in healthcare. Unfortunately, as we will explore in this series, some of these technological advances have led to some catastrophic results for patients. One need look no further than how the medical institutions rushed to implement the newest, shiniest and “best” radiology machines and through their haste left in their wake scores of maimed and dead patients. We reported on this investigation by NY Times reporter, Walt Bogdanich  in Eye Opener, over a year ago.

Just over the course of the last year or so, our firm has been involved in case after case in which this issue of medical technology and patient care/safety keeps rearing its ugly and devastating head. We will share with you (leaving identifying information obscured as we are required to do) tales of just how medical technology can impact – positively and (unfortunately) negatively patient health and safety. We’ll analyze and discuss our views on just how well medical technology and its implementation (more the latter) have, in our view, negatively impacted – all too often – patient health and safety. We invite you to follow along as we consider the good, the bad and the ugly of medical technology such as EMR’s, COW’s, iPads and the like. Please join us and share your comments along the way.

Some related posts to get you started:

The Radiation Boom – Radiation Offers New Cures and Ways to Do Harm

FDA Unveils Initiative To Reduce Unnecessary Radiation Exposure from Medical Imaging

At Hearing on Radiation, Calls for Better Oversight

Initiative to Reduce Unnecessary Radiation Exposure from Medical Imaging

The Story of How a New York Times Reporter – Walt Bogdanich – Has Made a Real Difference in Medical Device Radiation Safety

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6 Responses to “Medical Technology and Patient Safety: EMR’s, COW’s, iPads, etc. – are they really doing the job? Blog Series – Part I”

  1. Kaye MillerNo Gravatar says:

    I feel personally responsible for the develpment of EMR/EHR technology. My penmanship is legendary and I don’t mean that in a good way. Computer-based documentation is legible and streamlined. I must say the technology has at times prompted me to pause and consider what I’m placing in the chart. On the whole, it has honed my already keen nursing assessment skills by heightening the consciousness of my patient’s body systems. Free text is always available when the ‘click’ doesn’t tell the entire story.

    However, problems are ‘viral’, widespread, and problematic. To name a few:

    1. Facilities are not getting input from the potential users before purchasing. Cost and JC compliance is more
    important than useability. “Here is your new system. Make it work.”
    2. Seasoned nurses and ancillary staff are not given the considerations derserving of the huge
    technological changes. It’s a whole other language. A COW (Computer On Wheels) stands in the field.
    3. A culture clash has developed between nursing and the IT department who cannot appreciate the urgency
    of correcting problems.
    4. At my facility, there are 3 different systems. They don’t ‘talk’ to each other. Whose idea was that?

    I could go on; but you get the point.

    Regards,

    Kaye

  2. Brian NashNo Gravatar says:

    Kaye

    When I was writing this, I was actually (like in really!) thinking of you and a few of your compatriots. I just knew I would eventually see a comment by you! This is great – but – you let the cat out of the bag on COW’s – and I was going to have so much fun with that. :-)

    As you know, this is Part I of a series I intend to do, so I don’t want Part II to be this comment/reply. That being said, I really am not against EMR’s. I have spent so many years reading and “trying” to read handwritten charts (thus glasses, I’m convinced), that I really think they’re a great concept. It’s the implementation of EMR’s and some of the actual applications and their limitations (read – somebody sold some healthcare providers/institutions a bill of goods) that I plan on addressing.

    I have also seen the multi-systems that don’ “talk” to each other. Fascinating – to say the least. Anyway….more on all this later.

    Now for the invitation: I was actually going to email you about this, but what the heck, I’ll do it in a public forum. I know that you deal with these issues everyday you work (and probably on some of your alleged “off days.” I know you have lectured and written on these topics and posted them on FB at times. I would LOVE for you to consider doing a Guest Post to share some of your thought with our readers. Are you game? I’ll connect with you via email in follow-up. I think you have so much to offer on this topic.

    As always, much appreciate your thoughtful and thought-provoking comments.
    Brian

  3. You have really imparted useful tips/ knowledge

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    It really is interesting to see how much these items are used now – I think they can be good for keeping records, so long as they are all backed up, properly protected, and also people are being careful while entering things – it’s all about proper training and security measures for the items to succeed.

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