Tuesday, April 28, 2009
Electronic Medicine and How Doctors Practice
Electronic health records are being promoted as the answer to problems of health care quality and health care costs with electronic prescribing being the main example of improving care and lowering costs by automatically alerting doctors to safety issues and lower cost alternatives. It sounds great on paper but an article that was written in February in the Archives of Internal Medicine and more recently reported on in American Medical News shows that 90% of the time doctors get these alerts, they override them in order to order the medications that they feel are indicated. Even if these alerts are high severity, 89% of the time doctors override them. According to the authors, "existing alerts may provide little value to practitioners". They call for improvement in the alert systems and point out that the potential benefits of electronic prescribing may not be realized. In many ways, this is just an example of the danger of seeing automating a process as being a total answer. It may be one part of an answer but electronic records, electronic prescribing and other use of electronic media in the practice of medicine also has to take into account the people using that media and the training and cultural aspects of those people in order to be effective. Solutions must be real in practice and not just look exciting in a news sound bite.