05 April, 2015

A good piece about the choices in an implementation, and the feelings doctors can have about EHR-related screw-ups.

How Technology Led a Hospital To Give a Patient 38 Times His Dosage — Backchannel — Medium: Yet a series of dangers lurked beneath the placid surface. Installing a system like Epic is not like installing an operating system on your laptop, where you just “Accept the Terms,” reboot the machine and off you go. Instead, while the electronic health record provides the scaffolding, there are hundreds of decisions that each hospital needs to make, many of them related to electronic prescribing.

For example, should there be maximum dose limits set in the system, so that doses several times higher than the published maximum are grayed out? UCSF decided not to set such limits. The reasoning at the time was that, in a teaching hospital with lots of patients with rare diseases, many of them on research protocols, such “overdoses” would usually be okay. A system with hundreds of “hard stops” would lead to many angry phone calls from frustrated doctors to pharmacists, demanding that they override the block.