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Study Says E-prescription Systems Would Save At Least 50k Lives a Year
First time accepted submitter shirleylopez1177 writes "Approximately 50,000–100,000 people die in America because of preventable adverse events (PAE). These PAEs or medical errors are among the leading causes of death, ranking higher than breast cancer, AIDS and motor vehicle accidents in terms of the number of fatalities caused. As a response to the problem of medication errors, e-prescription systems have emerged. Few studies have looked at how e-prescribing systems compare to traditional systems in their potential to reduce medical errors. However, a study from Australia published two weeks ago in PLoS Medicine examined the impact of e-prescription systems on medication errors in the inpatient setting and demonstrated that these systems are indeed effective."
I worked on a hospital system 11 years ago that would provide this sort of cross-referencing functionality. It always baffled me why their use wasn't widespread. Back then there were (evidently) no smartphones, etc, so the whole idea of having barcodes on patients' wrists was revolutionary, as was the concept of having computer systems perform the drug-to-pathology matching and medication interactions analyses.
From what I learned working on that project, this sort of system can lower the costs of operation, staffing, and evidently lower risk inside a hospital. Does anyone out there know why they've not seen widespread adoption (besides the "obvious" tin-foil hat doctor-nurse-conspiracy theories)?
my e-prescription because the system was horked - doc could never get thru, scripts went unfilled, no connection between on-line status and reality, on-line gui blew monkey chunks...
Here in the UK, system like this are in use in both General Practice and in Hospitals. I worked for a company for seven years that supplied software that did precisely this to NHS and private hospitals both here an abroad. I wonder how the stats compare between the UK and the USA in this regard?
Stick an e- in front of it. Magic!
Nah, not gonna work - too much greed in the system.
How dare you replace a competent, well-trained, warm-hearted human with an emotionless machine?
My first program:
Hell Segmentation fault
Approximately 50,000–100,000 people die in America because they relies too much on prescription drugs.
Nowhere else on the planet do people take that many drugs in those quantities.
One thing I've wondered about is whether we should consider all deaths equal. Is it as tragic if an 80 year old dies from a presecription error as if a two-year old dies in a car crash? From the perspective of life span, the 80 year old likely got cheated out of 7-10 yeas of life but the 2 year old around 70.
My intuition tells me that a disproportionate number of these 50k deaths are individuals who are older or who are very sick to begin with. Comparing the # of deaths with breast cancer might not be the best way to compare.
Having said that I have been using E-prescription systems for a couple of years and I love it. Seems easy for the doctor, for me and for the pharmacy...
by implying that drug errors are causing 50,000 to 100,00 deaths a year when, in fact, drug issues are a very small portion preventable adverse events (PAE). Things like falls and catheter infections are far more common. The article mentions that drug allergies and cross drug reactions are already extremely low and unaffected by implementing e-prescription (probably because the computers in the pharmacy already alert to this). The only thing effected are illegible prescriptions. I think e-prescriptions are a fine idea but this article is misleading as to how much benefit it would have in terms of lives saved.
This won't prevent all events, only those caused by pharmacists being unable to read hand-written prescriptions. There will still be those resulting from doctors misremembering the name of the medication or a pharmacist grabbing a wrong bottle. No doubt it would save a lot of lives, but most of those would be saved by simply typing prescriptions instead of hand writing them.
Along the same line, however, there is a ridiculous amount of paper being faxed between doctors and between doctors and insurance companies that should have been eliminated long ago and replaced with email. I talk to people that do this, and they use the all-in-one machines to print both kinds of paper, but can't seem to comprehend the similarity of the two media. Perhaps the use of a secure method of communication, such as encrypted email, would finally replace faxes. Someday, even lawyers might accept the technology.
People should not fear their government. Governments should fear their people.
Where isn't this in use? My GP can order a prescription from is computer in the room. Same goes for any hospital, etc I've been in. The only thing that requires the actual script is scheduled drugs because it's (theoretically) harder to forge.
The summary (mostly) included one of the two key facts:
But not the other:
So the expected improvement is 22k to 44k less deaths per year in America.
Disclaimer: I work in the field, but am NOT associated with any particular vendor.
Even more effective than stand-alone eRx systems are Electronic Medical Record systems with integrated eprescribing. The ability to better track & manage patients' problems longitudinally provides for much better care and better outcomes.
I recognize that there are, however, some fairly major privacy concerns....many of which still exist at the ePrescribing level. Let's face it, if a system knows what you're taking, it doesn't take huge logical leaps to deduce your underlying conditions.
Article title assumes e-Prescription systems will solve most problems of the current system.
If rolled out into wide deployment, e-Prescription systems will have a lower success rate than they currently do in the hands of people who want them.
If abused with contempt, e-Prescription will perform worse than current systems, though if implemented with fidelity, the e-system could at least point a finger at the weak link in the chain, if anyone cares enough to analyze the records and develop witch hunt reports.
I got some shit advice from the medical staff at my university. I'm taking a drug called celexa and got a cold, not wanting any adverse interactions I called them up and asked what medicine it was OK for me to take. Coricidin Cold and Cough they said, was the safe choice.
I Googled it before I went to the store and found a major interaction via drugs.com. A potentially fatal interaction. Super.
Can lead to very bad things hipping
http://consumerist.com/2011/12/fda-warns-doctors-pharmacists-not-to-mix-up-similarly-named-eye-drops-wart-remover.html
How will it make money for the insurance and pharmaceutical companies?
Sure, those treatments may be costly, but ever thought that killing people reduces their expenses? You know their accountants are working out the odds.
More seriously, or perhaps even more conspiratorially, there will be people who think this is part of some massive intrusion into their life, and a clear violation of their personal privacy, and fight it tooth and nail.
That's why the US doesn't have EHR. Too many people don't want it.
We have this e-prescription system in Estonia for over 2 years now, nation wide. The good - It's easier to get some recurring prescriptions that you have to take all the time, you just calle the doctor and say you are running low on the meds, he checks your previous prescriptions and can easily see that yes, you should have only a few left... (to detect you are not attempting to scam extra medicines for black market or something). Also another good thing is that combined with an electronic pharmacy database, you can check online exactly which pharmacies currently have this medicine in stock in the right quantity(My partner takes meds that come in 10, 20, 30, 50 and 100mg forms, She only wants the 100mg ones). The bad - Initially they had performance problems because they forgot one basic simple thing when calculating peak usage - All elderly / pension receiving people(They are also the ones who require a lot of prescription medicines.) get their pension on the same day in the beginning of the month. This gives them a reason to leave the house and go to the city, and most of them also buy their medicines within the 2 days period following it, causing a massive performance bottle-necks for that moment(This problem was later fixed by adding more servers + optimizing).
And I hate them both! I have tried to make use of the CVS pharmacy automated refill system, but from what I can tell the "automation" goes into a blackhole and requires manual intervention. The system the doctor pushes is to fill out a form on their website, but from what I can tell it just generates a phone call from them to the pharmacy... sometimes. For me it is a major hassle, especially since my drugs are not considered "maintenance" prescriptions and have limits on getting insurance to cover mutli-month supplies. - HEX
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Not every medical error that causes death is a prescription error, so helpful as this system may be, it probably won't save quite as many lives as advertised.
The summary (mostly) included one of the two key facts:
But not the other:
So the expected improvement is 22k to 44k less deaths per year in America.
If the summary is correct (not a given!), there are 50,000-100,000 total PAEs. But only a fraction are going to be prescription-related, so the number of lives saved is probably much lower.
Sheesh, evil *and* a jerk. -- Jade
Since our society currently does not allow assisted suicide, please leave a loophole so doctors can prescribe fatal overdoses of morphine or other painless life cures. Terminal patients, people in vegetative states and miserable suicide-prone Goths everywhere will thank you.
It is interesting to me how almost Goedelian any set of rules can be. We always need to leave exceptions, or we strap ourselves into a Catch-22 (mixed with Brave New World) maze of rules that eliminate the finer points of decision making.
maybe we should build a F/LOSS platform for this so that it can be widely audited and its quality can be more transparently verified
Can you code in MUMPS?
in the public domain. VISTA is the Veteran Administration's EMR which has generally gotten very good reviews by physicians. However, it is an unbelievably archaic on the back-end (uses M, predates relational databases, etc.). In addition there is no emphasis on charge capture, so it often is useless for billing purposes.
Anyone, we often tend to forget that doctors are not experts in medication. The only know so much. Pharmacist and pharmacologist are the reference in this field... they are the one we should ask question regarding medical interaction.
I don't take a bunch of medicines, but my experience has been pretty consistent that doctors don't spend a lot of time talking about medication or dose, but pharmacists are very reluctant to question prescription-related decisions by doctors (eg, this medicine vs. another, dosage, etc) unless its an outright, PDR-printed contraindication.
Pharmacy in the US, at the level most people are exposed to it, seems to be one of those occupations that exists because of laws regulating controlled substances -- ie, you have to be a licensed pharmacist to dispense them. The pharmacy board and the professional associations make sure enough laws are processed that no company can dispense medication without having one on site, even though pharmacy techs seem to do the bulk of the work.
You almost wonder if the system wouldn't be better if a doctor's office employed a pharmacist; you meet with them after the doctor if a drug is prescribed. The pharmacy would just be a place to physically obtain the medicine.
It might cut costs, too, since a pharmacy open 14 hours a day could probably shave $200,000 a year in salary and benefits. That's an easy billion a year for walgreens alone.
My wife works in Assisted Living. She's had many situations where residents have shown signs of mental or physical degradation because of medication interactions. Not because one doctor prescribed interacting drugs, but because separate doctors prescribed interacting medications. The multi-specialist medical industry assumes that the patient is a medical expert, and can keep track of their medications AND know the interactions. All responsibility is in the hands of the patient. And guess what ? Most of us did NOT get medical training.
So a central clearinghouse system that red flags things isn't a bad idea. Most health insurance companies do it now anyway.. why ? Because they'd rather not pay for medication issues.
There's of course a darker reason... finding people who are 'doctor shopping' to enable their abuse of prescription drugs. The more centralized data is, the easier it is for a well meaning government to abuse that data for some sort of control. So...
do you REALLY want all your medications to become a public record (because we all know governments stink at privacy and security) ?
A final aside... some patients need medications that interact. My wife takes two medications that potentially interact. She's been taking them for years. But suddenly she 'cannot' because there 'is a risk'. Automating this refusal would deny patients who depend on these interactions for survival. Coding medical procedures is always a bad idea, because there has to be an exception process that involves actual human beings.
Just because they made an error, that doesn't mean a death resulted from the error. A patient's blood pressure may have shot up or down for a day, but (unacceptable though it is) they might have caught it and it might not have harmed him.
I'm not sure, but that claim that this is the leading cause of death in America seems a bit, uhm, off. I suspect there are some broad qualifications to that statement, like leading cause of preventable deaths?..
Interesting it didn't make this CDC list of causes of death: http://www.cdc.gov/nchs/fastats/lcod.htm
From the report:
Heart disease: 599,413
Cancer: 567,628
Chronic lower respiratory diseases: 137,353
Stroke (cerebrovascular diseases): 128,842
Accidents (unintentional injuries): 118,021
Alzheimer's disease: 79,003
Diabetes: 68,705
Influenza and Pneumonia: 53,692
Nephritis, nephrotic syndrome, and nephrosis: 48,935
Intentional self-harm (suicide): 36,909
Ken
We have a system developed here in Canada that is Open Source. www.oscarmcmaster.org has all of the information about the project and www.oscarcanada.org is the download location.
If the doctor could log in and select the medication and have the pharmacy read the prescription it would, on it's own, prevent a lot of errors that happen from misreading prescriptions. On top of that, if there is something wrong that requires a specialist then the patient is in a fun place where no one doctor knows what all medications are prescribed so a system that did any sort of automated conflict checking could save a lot of lives.
The current system is far from perfect, I once almost lost my job because some pharmacist misread my prescription for Singulair (Asthma med) and gave me an antipsychotic instead and for a week I couldn't be motivated to do anything.
A better solution would be that if the pharmacy cannot read the prescription, then they don't fill it. It should be the doctor who has the responsibility to make sure that what he/she is ordering is clear and understandable, not their receptionist or some clerk at the pharmacy. Doctors should be held accountable for prescription mistakes that are caused by their own haphazard penmanship.
If the summary is correct (not a given!), there are 50,000-100,000 total PAEs. But only a fraction are going to be prescription-related, so the number of lives saved is probably much lower.
Exactly right. While the discussion seems to be focused on the wrong medication being dispensed or even drug interaction, it is far more common that the correct medication, but at the wrong dosage is dispensed. Dosage errors are not going to be picked up by an e- system.
Slashdot addiction.
Religous speak to God. Insane are spoken to by God. When all shut up, one can finally hear Shostakovich in peace
The moral of the story is, it aint no panacea. It will remove a bunch of current errors, but create a new set of errors
I asked her to demand that the drop down auto complete suggestion box to be populated with the Logo of the drug, not just the name in text, also a confirmation window to pop up and stay on top off all windows for two to three seconds. The confirmation window should, display prominently the drug logo in correct color, based on the dosage picture of a baby/boy or girl/ small man or woman/ big man or woman, the picture of the organ that will be affected by drug. Pretty soon the doctors will develop a mental image of what the confirmation screen should look like and if anything is wrong, a simple "touch anywhere to cancel" action.
sed -e 's/Chuck Norris/Rajnikant/g' joke > fact
Put on your tinfoil hat real tight now....you might really need it this time.
The real reason for the push is so that the government can more easily track down to the nit picky detail what all ailments and treatments that every individual in the nation has. They intend to farm this data, not only for more control over our personal lives, but to look for certain specific trends. There is coming the day when even over-the counter drug sales... yes even NSAIDS and cough syrup sales will tracked in detail down to the individual. This is so that they can better detect that whenever someone has the beginnings of something really bad, like cancer and exhibits a sudden increased self-medication with OTC pain meds because he realizes that the new nationalized health care system will deem him to be uneconomic for proper treatment (e.g. the patient is an unemployed 55-yr old white male former construction worker with only high school education versus a 30-something yr old college professor) and because of this, the patient intends to stay out of the nationalized healthcare system altogether, the government wants to be able to early-detect these cases and single out that 55-yr old redneck since he'll know that he will get the shaft in the government medical system, and since he's approaching old age and death anyway, the government fears that he will much more likely "twist off" and commit an act of domestic terrorism against the government.
Sincerely,
Dale Gribble
Thank you for your bitcoin advertisement. Now to return back to reality.
And in keeping with tradition; the doctors would write them in COBOL while the pharmacy writes in BASIC.
Because non-tech people usually don't understand the "computer is a universal tool" thing and have problems stretching the limits of their imagination ("I had no idea a computer could do that for me...")
Because IT evangelists think that every problem in the world can be reduced to computer code, and they create medical systems without understanding how medical practice works.
Then the doctors try the system out, it runs into problems ("It takes me longer to enter a prescription into this computer than it does to write it on a prescription blank by hand"), and they correctly go back to the older manual systems that work better.
Doctors aren't stupid. They use lots of new technology every day. When something works, they use it. When it doesn't work, they drop it.
Medical practice is very complicated. The potential cost of error is very high. The cost of developing electronic medical records properly is very high. It's like developing a medical drug or device (which it is). You have to get back to your users (the doctors) continuously, find out what's going wrong, and fix it. Automating medical practice is a massive job, like automating the aerospace industry. At best, it will be slow and expensive. At worst, developers will take shortcuts, waste even more time and money, and have to scrap it all and start over.
I'm glad you asked. "The system" needs to stay out of this and leave it up to doctors and family members. I trust those more in general than government. For example, if we leave a loophole, assisted suicide will be legal. Some people will be murdered, no doubt. However, if we legislate away the possibility of covert assisted suicide, no one can have that privilege.
A recent study found that 1/12 or 1/8 (can't remember which, so call it 1/10) of electronic prescriptions had an error. Types of errors include: wrong medication, wrong dose, wrong instructions, wrong quantity. I do dozens of electronic orders a day and get several kicked back to me from the pharmacist.
First, medication errors are only part of preventable accidents.
I spent years trying to get pharmacies to automatically deliver a 11 page summary of a patient's meds with every order. Software companies assured me this was trivial tio generate on all the most common systems.
Pharmacy chains were universally uninterested. So were insurance companies.
I'd figured, based upon experience with providing my provider with such a list at every visit, that this could save 5 minutes per visit, and greatly increase the accuracy of the data--since the more meds you take, the harder it is to remember them and their dosages and who prescribed them.
Now, of course, most pharmacies & medical facilities hand out such lists, in varying degrees of completeness--but they are often still very long documents rather than summaries.
The reason for what I considered a profoundly stupid lack of interest in a very low-cost way to improve the system didn't come to me until the latest health care arguments in Washington...then it became obvious.
Under the current system, there is no incentive to lower costs, and every incentive to increase costs.
There is no one in the health care system who doesn't profit based upon # of treatments rather than the level of health maintained in the population they serve. In fact, the most profitable patients are those who never get well and don't die, as they require the most treatments.
Not news, that was what HMO's were supposed to reverse--but didn't.
A major cause of errors is simple fatigue. Medical staff work far more hours than it is possible to work while maintaining tthe level of accuracy required in life & death matters. A recent study showed that adding 3 hrs/week of sleep to Drs reduced their error rates by 30%. This same kind of effect can be found across professions. As a programmer, I learned years ago that coding more than ~10hrs/day resulted in having to spend much more time correcting errors.
Worse, shuffling people among shifts drastically reduces their abilities--and we do this with emergency workers routinely...in a manner guaranteed to ensure that these people are always at their worst.
It takes weeks to acclimate to a new shift, and invariably, shifts are changed just about the time people have adapted to their current shift. This isn't new--we've known this for decades. But we do it to the very people we depend upon in crisis.
If health care made more money for keeping people healthy than for treating them, the patient load would tend to drop (in most automated manufacturing, if you see lots of people being active, it means you're lossing money--a profitable shop has machines buzzing away while people hang around and watch.)
Since people facilities would make more profit the fewer patients they treated, much more time could be spent on teaching patients to stay healthy, on staff training, on facilities maintenance, on new equipment. Hospitals would go from the current crowded, noisy and inefficient situation to a much more relaxed environment overall.
So long as income is on a 'cost plus' basis, and based upon treatment rather than health, it is not a health care system, because the ideal (profitable,) patient never gets well, never dies, but requires frequent examination and treatment.
This is the single best argument I've found for government health care, but it does require patient health analysis and because the issues are complex, there will be no single, simple solution--you have to take into consideration the kinds of patients a dr treats--someone who specializes in, say pancreatic cancer will invariably have the vast majority of patients require much treatment before they die. A GP doesn't have the same patient profile.
I've been in & out of the system extensively for 15 years a as a patient. I've never been hospitalized without errors in treatment--noe of which were fatal, but several could easily have killed me.
That, is a horrible track record, mostluy because it se