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2/5/2009
09:41 AM
Bob Evans
Bob Evans
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Is Hospital Tech Study A Breakthrough Or 'Vioxx Moment'?

Researchers looking for links between the quality of hospital IT systems and patient mortality said their results show "extraordinary outcomes" when hospital tech is well-planned and easy to use. But a physician blogger reviewing the study said its findings are "alarming" and a "possible Vioxx moment." With $20B in health care funds looming, we'd better figure out who's right.

Researchers looking for links between the quality of hospital IT systems and patient mortality said their results show "extraordinary outcomes" when hospital tech is well-planned and easy to use. But a physician blogger reviewing the study said its findings are "alarming" and a "possible Vioxx moment." With $20B in health care funds looming, we'd better figure out who's right.The new research used a detailed questionnaire called a "Clinical Information Technology Assessment Tool" to measure the level of automation in clinical information processes in 41 urban hospitals in Texas. The study's author, Dr. Ruben Amarasingham, was quoted in a recent story on ScienceDaily.com as saying, "If implementation is done well, health information technologies can be hugely beneficial for patients. To our knowledge this is the largest study of its kind examining hospital information system capabilities from the perspective of the physician."

OK, so far, so good. But complications arise when the authors attempt to link significantly improved outcomes for specific health problems with use of specific clinical IT tools, such as computerized physican order-entry, according to a post on the "Health Care Renewal" blog, which is written by physicians for physicans. Here's how blogger "S.S" described his concerns:

"Having designed highly customized, detailed information systems for outcomes improvement and mortality and morbidity reduction in invasive cardiology, I am fascinated by suggestions of significant mortality risk reductions in Myocardial Infarction (MI) and Coronary Artery Bypass Grafts (CABG) related to usage of (non-specialized) Computerized Physician Order Entry (CPOE) technology.

The authors acknowledge that there are many possible confounding variables in this study, which is based on surveys of physician health IT usage and hospital reporting data, not on far more robust randomized controlled trials. While I agree with the authors that followup validation of this cross sectional study's findings are needed, I do have a concern.

I am troubled by the implication of such a cardiology mortality reduction based on CPOE use, if real.

If this finding is real, one implication is that increased MI and CABG mortality in organizations *not* using CPOE are due to preventable errors of omission and commission in ordering. Importantly, these errors do not necessarily require expensive computers to correct. They can be corrected through human means.

While this reduced cardiology mortality association sounds possibly spurious on the basis of this implication, in my mind this is an alarming finding, potentially meriting prompt and comprehensive investigation.

After a possible "VIOXX moment" is discovered, just how long do we as a society wait before conducting a more thorough investigation?

S.S. also urges greater research into precisely what impact health care IT has on patient outcomes, particularly because of the federal government's pledge to invest $20 billion into health care research in the coming years, and he specifically warns that less-than-rigorous studies could well "create more problems than the solve":

Finally, the following question also arises. Do observational studies of HIT, subject to confounders and false conclusions of causality regarding associations, possibly create more problems than they solve? For example, the "red flag" described above? Are such studies -- as opposed to robust controlled clinical trials -- akin to unnecessary medical testing that finds anomalies and "unidentified bright objects", resulting in more fritter that wastes time and money?

Stay tuned for further updates.

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