One might ask: how many unreported or yet-to-be-reported EHR/CPOE cases involved, or will involve,
permanent harm?
Sept. 9, 2012 Addendum: We learn this from Healthcare IT News (http://www.healthcareitnews.com/news/ehr-adverse-events-data-cause-alarm): "Sparnon said two of the reports involved temporary harm that required initial or prolonged hospitalization." I note that hospitalization, especially prolonged hospitalization, exposes the patient to still more risk.
Regarding the "temporary harms", one which includes "default times" as opposed to doses:
The four cases requiring intervention involved accepting a default dose of a muscle relaxant that was higher than the intended dose, giving an extra dose of morphine [keep playing with 'extra doses' of drugs like morphine enough, and you're going to kill someone - ed.] because of an accepted default administration time that was too soon after the last dose, having a patient’s temperature spike after a default stop time automatically cancelled an antibiotic [do this enough, and you're going to get sepsis and septic shock to deal with - ed.] and rising sodium levels in a patient because confused wording made nurses believe that respiratory therapy was administering an ordered antidiuretic. [Apparently the 'default'- ed.]
More on the errors:
The most common types of errors in the study were wrong time (200), wrong dose (71) and inappropriate use of an automated stopping function (28).
Any of these, especially the latter two,
could have caused harm depending on degree...and to those Risk Management majors out there, eventually
will. “Many of these reports also showed a source of erroneous data and the three most commonly reported sources were failure to change a default value, user-entered values being overwritten by the system and failure to completely enter information which caused the system to insert information into blank parameters,” Sparnon says.
Hence my claim that the term "EHR" is anachronistic, and that these systems now are really
cybernetic command-and-control mediators and regulators of care (via cybernetic proxy).“There were also nine reports that showed a default needed to be updated to match current clinical practice.”
The need for a constant, rigorous updating process (which will in the real world likely always be 'behind'), among
many others, is a factor that makes the idealistic belief/promise that "health IT will save money and increase safety" (let alone "revolutionize" medicine) unpersuasive.
I note that the "default values" risk is only one of many, many "features" of EHRs and other clinical IT that cause risk and error. This issue is but one layer of a very, very large and multi-layered onion (cf.
AHRQ Health IT Hazards Manager,
http://healthit.ahrq.gov/sites/default/files/docs/citation/HealthITHazardManagerFinalReport.pdf, for example).
And this, at the same time that the The HIT Policy Committee, a body of industry stakeholders who advise federal officials, on Sept. 4 adopted final recommendations on health IT risk consistent with an attitude of health IT exceptionalism that included:
"HIT should not be subject to FDA [or any - ed.] premarket requirements" and "Vendors should be required to list products which are considered to represent at least some risk if a non-burdensome approach can be identified."
If not, no list? ... And what, exactly, is a
"non-burdensome" approach, one might ask?
(See
www.healthdatamanagement.com/news/health-information-technology-regulation-fda-onc-fcc-46557-1.html)