One of my required courses for HIT is “Health Services and Information Systems.” This week, we’re going to be engaging in a discussion on “current trends in the development of health information systems.” Our professor introduced the subject with a question: “What is CPOE and why do you think it has become such a growing trend?”

For those who aren’t familiar with the acronym CPOE, it stands for “Computerized Physician Order Entry,” and claims to be able to reduce the incidence of serious medication errors by over 50%. This calls to mind similar claims made by the proponents of “Computerized Patient Records,” for example:

“Computerized patient record systems can help improve the quality of care provided, for example, by providing real-time patient status reports, test results as soon as they are available, and graphs and flowsheets of test trends. They can help reduce costs by eliminating many manual functions and the supply and staff expenses associated with these functions. Finally, they can provide practices the data necessary to attract and negotiate favorable managed care contracts.”

From: Computerized patient records benefit physician offices

Since the term “CPOE” isn’t mentioned anywhere in our text or lectures, I decided to Google it. I was able to come up with quite a bit of information. One particular web site, The Commonwealth Fund, which describes itself as “A private foundation working toward a high performance Health System.” had an article entitled: “Overcoming Barriers to CPOE.”

Following is how they described the “barriers:”

Barriers and Strategies to Overcome Them

Physician and organizational resistance was one of the top barriers cited in the interviews. Physicians seemed to believe that CPOE systems would create more work and that the traditional paper-based ordering method was faster. Some hospitals abandoned implementation plans, fearing that physician resistance could escalate to a point of “physician rebellion.” The interviewers also noted low levels of computer literacy among some physicians and a lack of user involvement in implementation processes. [...] (emphasis mine)

From: Overcoming Barriers to CPOE

To their credit, after they proposed “Involving younger, computer-savvy physicians in the implementation process” as a stragegy to overcome the barriers, they also metioned cost, and the immaturity of the systems themselves.

An earlier article in “ACP Online” entitled “Doctors are the main barrier to computerizing records” states: “the primary barrier to adopting EMR technology [...] is physician resistance.”

I find this a bit odd, since most of the physicians I know are computer savvy, and some, like Dr. Bob, have even written their own EMR software … and Dr. Greg P. from Information is Free even builds/rebuilds his lap top!

So then, what’s the problem? Is it as The Commonwealth Fund intimates … that much of the resistance is due to older, technologically challenged physicians? I’m not sure I fully buy that. Without too much effort, I can think of three retired physicians who are computer savvy enough to blog: Dr. Hans Engel of “In a Doc’s Mind,” Dr. James Gaulte from Retired Doc’s Thoughts, and Dr. Maurice Bernstein from the Bioethics Discussion Blog. Perhaps these are rare individuals, but I’m certain that if I applied myself a bit, I wouldn’t be too hard put to find other such “rare individuals.”

So … what is it, really?

Sometime in the not too distant future, I hope to work on writing and implementing biomedical databases. Although many of my fellow students will probably settle comfortably into an HIT transcriptionist’s job, that’s not where I intend to go. I’d like to know why you would, or would not, choose to use electronic media, such as EMR’s and CPOE’s in your own practice. If you don’t use them now, what would cause you to consider upgrading? If you do use them, are you satisfied with them? Why or why not?

Your opinions and ideas will be passed on to my fellow students, and we can carry the information with us when we enter our respective Health Informatics fields. Who knows how far your voice could carry?

Dr. Maurice Bernstein of the Bioethics Discussion Blog has a knack for getting people to say what they really think. He asks the hard questions … the questions that give you pause, and make you wonder if you really want “go there” in public …

I must admit that I’m a frequent visitor, and I’m about halfway through reading his blog from beginning to end, since I only found him sometime last fall, and he’s been building up that amazing blog for a very long time.

On July 5th, Dr. Bernstein outdid himself. He put up a post entitled: Male Circumcision: Should It Now Be A Crime? In the next 17 days, it accrued 441 comments!!! It could have something to do with Blogger, but on the 17th day, the comments suddenly stopped – so to ensure that the conversation was able to continue playing itself out, Dr. Bernstein made a new post on July 25 – More on the Issue of Male Circumcision – and the comments have resumed in the new location.

In an email exchange between Dr. Bernstein and I, he said:

If these vocal visitors represent a general part of the patient population, I think it is important to recognize that and now I have some new insight to tell my first and second year medical students next month. We have never discussed the issue of infant male circumcision with these students in the past. I think it is important, perhaps for the students to simply look at my blog, to see how explosive the issue is to certain patient populations..so that they can be prepared.

What I’ve been able to gather from the comments is that, in spite of the sheer volume of comments, there are relatively few individuals in the discussion. They seem to be people with strong opinions, and in some cases – extreme opinions. I’ve discussed the issue with several men, and none of those I’ve spoken with are against circumcision – so far. I wonder if perhaps the commenters on Dr. Bernstein’s blog may not really be representative of the “general part of the patient population,” but could perhaps only belong to a small, albeit extremely vocal, minority.

I’d like to hear from those of you with an opinion on Male Circumcision – especially infant male circumcision. Are there medical reasons to promote it? Do you consider it to be a form of genital mutilation, or child abuse? I don’t think that my blog attracts the same crowd as Dr. Bernstein’s blog does, and I would like a more balanced view to present Dr. Bernstein and his medical students with.

My regular readers can ignore the following warning …

Nota bene: If you post a rude comment, or use cursing, name calling, religious slurs, personal slams … etc. … your comment will be deleted! I’m not as patient with rudeness as Dr. Bernstein seems to be, and I’m interested in hearing everyone’s polite opinion – all sorts of opinions – but I’m not interested in having an argument begin in the comment thread. Play nice, and you get to have your say. This blog is not a “democracy.”

Made a trip up to Gray today, and shared a meal with some old friends. We met at a restaurant there called Cole Farms. This place was built in 1952, and is a large part of my earliest (and best) memories. Just 15 minutes south of my home town, it’s grown from a tiny little clam shack, to a huge, two story enterprise that almost always has a bit of a wait. The pies are made on site daily … and the potatoes are real! They don’t take credit cards … but they do offer some of the best food, for the best prices, anywhere around. This isn’t a just another restaurant, it’s a local “institution!” Click on the link and a take a look at the little movie in the left side bar of the web site.

Althea, my Mom-in-Law, drove up with Dougie and I. We met with Fr. Bob, who had come up from Gorham, and his brother Emery, and Emery’s wife Sylvia, who drove up from Westbrook. Joanie and her Mum, “Aunt Pauline,” drove all the way down from Bangor.

These little meetings are getting harder and harder to arrange. If things work out the way I expect them to, by late this fall, this sort of thing will become completely impossible for us. This is a year of change for most of us.

Here are a few pics that I’d like to share with you of today’s little jaunt …

Before heading back for Berwick, Dougie, Althea and I drove up to my home town, Lewiston, and I paid a visit to the cemetery where my parents are buried. We made a quick nostalgic pass through town, and just before we crossed the bridge over the mighty Androscoggin on our way out of Lewiston, the car overheated, and I had to pull over and let it cool off.

While I was there, I took a picture of the falls. This is taken from the Lewiston side of the Lewiston/Auburn bridge.

Funny thing … no matter how old you are, there’s always a tug whenever you return “home” again. This time was especially poignant, because the school I went to has been torn down, and nothing is left but a huge heap of bricks. I could almost see all of my little school-girl memories, buried underneath the pile.

I think the most difficult thing of all, though – is the realization that the place I grew up in is now occupied by people I’ve never met. If I were to march back into the kitchen, my Mom would no longer be sitting quietly in the rocking chair … my Dad wouldn’t be there in his long johns, reading the paper. The kitchen would be different, the people would be unfamiliar. They wouldn’t welcome this intruder into their domain. It wouldn’t matter to them that I know those walls intimately … that I spent all of my childhood playing on those floors, and knew every corner, and every crack. The voices filling the house would be painfully unfamiliar.

You never outgrow the desire to find home again, somehow … even when you know that it no longer exists.

I’m trying out some new spam software … so, if you try to leave me a message, and it gets gobbled up, or you get a message calling you a spammer, I’d like to know. I hear the plug in is quite good, and that sort of thing shouldn’t happen, however, since I haven’t used it before, I’ll be feeling a little cautious about it until it proves itself to me.

The last thing I want to do is miss genuine comments.

It’s called Spam Karma 2, and this is what it has to say about itself:

The Machine

Spam Karma 2 is the proud successor to Spam Karma, with whom it shares most of the development ideas, but absolutely none of the code. It is meant to stop all forms of automated Blog spam effortlessly, while remaining as unobtrusive as possible to regular commenters.

So … I want to know if it blocks any of you … if it does, first of all. please forgive me. I read that the spam messages can be pretty raw, although I haven’t seen them myself. Email me and I’ll see if I can figure out how to configure the thing properly.

Thankee!

This theme isn’t quite ready yet … I’m still missing a lot of basics: archives, site meter … etc. I’m going to try to get at least the simple stuff up gradually over the next week or two.

Would love to know what everyone thinks of my new theme! As you comment, please note that I have a “live comments” plug-in activated. Let me know what you think of it!

This theme may still have a lot of bugs. I had to work my bippy off to get a sidebar on the right side of the screen, and I never was able to get a footer to go where I wanted it to. From what I’ve been able to gather at the Word Press help forum, that sometimes happens … *sigh* … anyway, please let me know if you run across a bug! I’ve tried this out in both Firefox and IE, and to my utter amazement, it looked almost the same in both.

As I build the blog back up, I intend to be careful of what I put in so that the blog doesn’t get too cludgy again. I need to know when I put something in that balls up the works! If you don’t tell me, I won’t know!

That’s it for now. I thank you in advance for your input!