For those of you who actually use Windows Vista, what do you do when the User Account Control pops up a message like the one above?
Maybe the first few times you read it and see what the program is all about. After that, you glance at it when it pops up and click “Continue”. After a month or so, it grows to be a real pain in the but-tocks and you tend to ignore, or even get frustrated with it.
A recent Archives of Internal Medicine study titled “Overrides of Medication Alerts in Ambulatory Care” shows that the same concept holds true when doctors prescribe medications through a computer program.
Researchers studied more than 3.5 million electronic prescriptions written using a specific electronic prescribing system in several states between January and September 2006. They tracked 2872 total clinicians, looking to see how the clinicians would respond to “alerts” programmed into the electronic prescribing system. Alerts were programmed for allergies to medications and for potentially dangerous interactions between drugs being prescribed.
Of the 3.5 million prescriptions tracked, roughly half a million total “alerts” were generated by the electronic prescribing system. Half of those alerts were excluded by the researchers because they were “duplicate” alerts that occurred after the prescriber overrode the first alert.
The remaining 233,000 alerts were then studied to show how often prescribers accepted the alerts. Not surprisingly, the alerts were often ignored. “Drug-Drug Interaction” alerts were overridden 91% of the time and “allergy” alerts were overridden 77% of the time.
The researchers concluded that “Given the high override rate of all alerts, it appears that the utility of electronic medication alerts in outpatient practice is grossly inadequate … For active clinicians, most alerts may be more of a nuisance than an asset.”
I had three other thoughts about the study.
First, it proves that the more you computerize patient records, the more that the data will be tracked and analyzed. I really believe that data mining is the major impetus for the electronic medical record initiative pushed by the government.
Second, it shows how forcing clinicians to jump through more and more micromanagement and regulatory hoops in order to practice medicine won’t necessarily have the intended effect. It would be interesting to compare the productivity of the clinicians before and after the electronic medical record system was instituted.
Finally, the study shows that at least some of the “warnings” about drug interactions and drug allergies are theoretical ones and not clinical ones.
There were a quarter million prescriptions written in this study that were against the better judgment of some computer program.
Even though the prescriptions were written in 2006, I still haven’t heard about all the gloom and doom adverse patient outcomes tied to those those hundreds of thousands of transgressions.
Could it be that there were very few adverse outcomes and that the “warnings” were mostly overblown?
Like to see those study results.