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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)?
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!
How dare you replace a competent, well-trained, warm-hearted human with an emotionless machine?
My first program:
Hell Segmentation fault
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.
Approximately 50,000–100,000 people die in America
WHICH America? North or South?
Upward mobility is a slippery slope - the higher you climb the more you show your ass.
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.
Approximately 50,000–100,000 people die in America
WHICH America? North or South?
--
"You can always count on Americans to do the right thing - after they've tried everything else." - W. Churchill
WHICH America? North or South?
<xml><I><am><so><damn>Web 2.0</damn></so></am></I></xml>
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
If they are preventable deaths, yes they are equal.
Gone!
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).
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 very sick to begin with.
Your numbers are way too high. Taking, say, my grandmother into consideration, depending on the prescriptions selected, some years ago she had the choice of dying of heart/circulatory trouble, lung trouble, or kidney trouble. Technically the doctors may have made the "wrong" off the cuff under fire multidimensional optimization thus robbing her of hours, perhaps even days of life. Not 7-10 years. As an engineer, I think they did pretty well, but I can see how someone brought up with rich Dr always right on pedestal above us all never wrong might want to file a malpractice lawsuit for those couple hours of life in exchange for what they think will be a big financial payoff. Or, a deal where you guys are trying to bill a uninsured widower for $2M of "service" but we will "overlook" the malpractice if you "overlook" the $2M bill. Etc.
Ditto the kid. So my son had horrible flu and pneumonia (and eventually made a 100% recovery thanks) but in the ER they had to decide to risk hard core IV antibiotics that he might be allergic to vs fluid in lungs vs high fever needing IV (whatever it was) to drop his temp which also has side effects, etc. Now if they had guessed wrong and he croaked, VERY superficially you might claim he lost 70 years of life, but lets be realistic, a semi-dehydrated little kid with the flu and a high fever and trouble breathing, without any medical intervention his lifespan would have been, what, maybe a day or two at most? Certainly not 70 years. A kid that sick in Africa would be dead for sure.
"Science flies us to the moon. Religion flies us into buildings." - Victor Stenger
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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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.
It's no conspiracy! I know a guy who knows a guy who has an e-prescription, and they deliver his drugs at night with Black Helicopters!
Also, caused autism in his nephew's dog.
Sheesh, evil *and* a jerk. -- Jade
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.
You two have a good understanding of the tradeoffs involved with decision-making. Unfortunately, many people do not and see suboptimal outcomes as "errors" in a very black-and-white world. I think the IOM report fed into many fears.
I am continuously annoyed about the IOM report -- as other posters have said, it is now out of date, and sensationalist IMO in the way it counted mistakes and deaths / errors. An "error" that had no effect in a critically ill patient who died 3 days later was counted as a fatal outcome. On the other hand, the sensationalism at the time might have been a bit warranted -- doctors are often very complacent and perhaps the attention was needed / desired to get large scale action. However, it had the side effect of the erosion in trust in those that work very hard, diligently, and conscientiously every day.
I very, very rarely use handwritten prescriptions. Certainly as inpatient (patients who are currently in the hospital) essentially all major medical systems have computer order entry as of 2012. In my outpatient clinic (people just coming for a doctor appointment) it is 100% computer medical scripts with automatic interaction and allergy checking. All of my hospital system is this way.
I can't remember ever having ANY medication or dosing error. Obviously I can't know about it if I don't catch it, but computer order entry, automatic checking, and the many layers of check from doctor, nurse practitioner, pharmacist, and nurse, (and patient!) does provide a safety net.
Can we do more? Well, banning handwritten prescriptions would be a pretty bad idea (if I'm in a community clinic wanting to give a patient some antibiotics for an ear infection, I think I should be allowed.) There are side effects to every initiative. Encouraging computer use is indeed being done, but limited by cost concerns.
Slashdotter, ID #101. UIDs are in binary, right?
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?
WHICH America? North or South?
Neither.
I know that this is hard for some people to understand, but let me spell it out again, as simply as I can. In the most common usage:
North America is a continent.
South America is a continent.
America is a country.
I know that this reality may not seem logical to some of the overly literally-minded people around here, but too bad. Much of the English language and its common idioms don't make literal sense. Deal with it.
WHICH America? North or South?
The America that people around the world generically use to refer to the United States of America. It might have something to do with America being the largest word in the country's name. When Iranians chant 'death to America', they're referring to the USA. Not Canada. Not Brazil. Not Mexico. Just the USA. Everyone gets this reference except people who have to ask 'WHICH America? North or South?' They're so fucking dense they go around wondering if Iranians want death for all countries in the Americas or just in North or South America. Maybe if Canada, Mexico, Brazil, Argentina, or any other major country in the Americas had America in its name there might be some confusion. But they don't, and there isn't.
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
...sensationalist IMO in the way it counted mistakes and deaths / errors. An "error" that had no effect in a critically ill patient who died 3 days later was counted as a fatal outcome.
Yikes, so you're saying a gunshot wound bleeding out who doesn't get a required tetanus shot would be counted?
Can we do more? Well, banning handwritten prescriptions would be a pretty bad idea (if I'm in a community clinic wanting to give a patient some antibiotics for an ear infection, I think I should be allowed.)
I have not ready any /. comments about fraud / prescription abuse, what do you think about that WRT to handwritten vs e-prescriptions? Fraud w/ paper is harder to detect (or is it?) and when it happens I would assume thats one order at a time, whereas online I'd assume if you get owned you'll suddenly insta-prescribe 100000 orders of some abuse drug. You could design systems for both paper and online that are either secure or insecure, I'm sure paper has been optimized and electronic has not been optimized as much...
"Science flies us to the moon. Religion flies us into buildings." - Victor Stenger
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
Contrary to popular southern belief America hasn't been divided into North and South since the end of the civil war.
One could take your argument the other way though. A two year old doesn't even have significant brain function yet, they haven't done anything for society, they haven't learned any skills, so they worth much. The 80 year old has 80 years of experience and learning and probably has children, grandchildren, a spouse, assets, and in many cases a fully functioning brain to recognize them all so they've earned their ten years.
Personally I'd value an 18-30 yr female at a much higher rate than either. 18+ yr old males who are not me or tasked with serving me in some way we can kill off.
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
[The United States of] America
Morally, yes. Financially, no.
The tetanus shot would be tracked as a quality measure rather than a med error, but yes, that's actually how most of this stuff works.
At least in my state, you must hand write prescriptions for controlled substances on a fraud-resistant pad (the sort that can't be photocopied).
The IOM report did grade error severity - they're not that dumb. The press, as usual, didn't pick up on that nuance. The IOM report, however, didn't do a very good job of grading error severity. In particular, it did not look at any metric like quality-adjusted-years-of-life that would balance a small error made in an elderly terminal patient. That was likely intentional since the thrust of the report was to say 'hello! Beuhler! wake up!'. Subtleties can come later.
Unfortunately for US medicine you have an enormous, many tiered complex system with numerous stakeholders with often competing interests simultaneously spending a significant fraction of the GNP while running out of money. Makes it hard to change things on a system wide basis which is exactly what we need to do - it's not just tossing a computer into the mix as computerizing chaos usually just yields computerized chaos.
Faster! Faster! Faster would be better!
You should try travelling south of your border sometime. Pretty much everyone else in the western hemisphere would consider it at least slightly offensive to imply that 'America' refers exclusively to los Estados Unidos
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.