I was happy to read [Dr Richardson’s] March editorial (BCMJ 2014;56:73) last week—I am seriously behind on my reading. I was beginning to think I was the only one in Fraser Health who wasn’t convinced that computerization is the solution to all our problems. Of interest to you might be an article published in the May 2009 issue of the Journal of the American College of Surgeons. It is the only article I have found that looked at what happened to a physician’s time and workload when a physician order-entry system was introduced. Because hospitals and health regions don’t pay for a physician’s time, there is no incentive for them to develop or introduce a system that saves us time and work. The prevailing attitude is that technology in action is always better than any current system—a system that has evolved and adapted over the years and works very well. Even in the US, where they are pretty brutal about firing and laying off excess workers, there were no cost savings or safety improvements with the introduction of the system.
I am only a semi-Luddite, but like you I can’t see how the one or two computer terminals are going to accommodate the 10 or 12 physicians doing rounds at any one time between 7 a.m. and 9 a.m. Maybe they are going to introduce a reservation system. I have never seen a business plan for EHR implementation and, as you have rightly pointed out, no one is going to have their job eliminated to fund the system. As far as I can see, it is simply a huge amount of money being spent on administrative matters while clinical funds dry up.
On a related subject, you might find an article in the 13 March 2014 issue of the New England Journal of Medicine also of interest. Checklists have been the—and I mean the—linchpin of the culture of safety that administrators have been pushing on us. In short, there was no difference before or after the checklist, despite the significant amount of money and time invested in the introduction and use. Do you want to bet that the science will be ignored because the safety industry would be out of business?
—Norman Causton, MD
1. Stone WM, Smith BE, Shaft JD, et al. Impact of a computerized physician order-entry system. J Am Coll Surg 2009;208:960-967; discussion 967-969.
2. Urbach DR, Govindarajan A, Saskin R, et al. Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med 2014;370:1029-1038.
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