Seeking to balance empowering patients and increasing safety with not overburdening healthcare providers, the HIT Policy Committee is preparing specific questions for public comment about its Stage 2 matrix.
During a meeting held to fine-tune the questions, workgroup members slogged through each of those points, often attempting to locate the balance of empowering patients and increasing safety on the one hand, with not overburdening healthcare providers on the other.
The group also sought to avoid unintended consequences. For example, a discussion of clinical-decision support -- the element of CPOE thought to hold the greatest value -- raised the point of how relevant primary-care medication-related warnings may be to specialists. The goal of the exercise was to ensure that specialists aren't forced to endure "alert fatigue," or being bombarded by useless warnings which then cause them to ignore all.
"With regards to the elderly, (gerontologists) use dosages and medications that primary care provider might not use, so they wind up getting triggers that aren't relevant," said Neal Calman, M.D., president and CEO of The Institute for Family Health. "As these things are developed, we need to make sure that specialists are not being harassed by messages that would be relevant to a primary but not their specialty."
On this point, however, David Bates, M.D., chief of the division of general internal medicine and primary care at Brigham and Women's Hospital, and James Figge, medical director, office of health insurance programs, New York State Department of Health, disagreed. They felt that rather than being pestered by the alerts, specialists would benefit from them.
With such a difference of opinion, it was agreed this was one area ripe for public comment. "The question is what do people know out there about best practices? How do we make this more relevant to the specialty areas?" said Calman.