From Trust to Reliance

Yesterday I noted how deeply the concept of trust is intertwined into everything we do in healthcare. It really creates a web of interdependent individuals, organizations and systems, each of which must trust that the other is effectively carrying out its role in the overall delivery of healthcare. Now the Leapfrog Group has issued a report summarizing the results of its computerized provider order entry (CPOE) evaluation tool. The data gathered between 2008 and 2010 will be of interest to anyone wondering whether CPOE should be included in the first level of meaningful use. According to the report, over 200 hospitals tested their CPOE systems to see if they caught common medication errors, including those that could be fatal. On average, the systems missed about one-half of the routine medication orders and a third of the potential fatal orders.

Leapfrog recommends testing and monitoring for all technology adoption, and that best practices are shared more transparently. “Competition is healthy, but in the case of IT adoption, collaboration is far better” the group notes. The group further recommends more implementation of CPOE, which can, when set up correctly, reduce medication errors. Fair enough. And now some questions:

  • How do we determine the best practice? Are there “flavors” of best practice for different demographics?
  • How can that best practice be represented and supported by our technologies in an efficient way?
  • How can we keep it current?
  • How do we begin moving from “having CPOE is good” to “having good CPOE is better”?
  • How can we integrate and begin to depend upon technology that is still evolving while maintaining quality in a high-risk, high-stakes environment?
  • Is it ethical to use technology to support patient encounters when we know the technology is still in its infancy?

The last two questions are most interesting, and probably the most challenging. On one hand, we are trying to create technical support systems that can reduce risk and alleviate some of the burden by transferring some of our knowledge responsibilities to the technology. On the other hand, we add to the risk and the burden because we must ensure that this technology mentoring process does not result in lower quality care, or deaths. In short, how do we know when it’s okay to begin trusting our systems? And coming to trust our technology is not the same as coming to rely on technology. Trust is a forerunner to reliance, and it holds true for the patient – physician relationship too.

-Rod Piechowski

Copyright © 2010, Rod Piechowski, Inc., Consulting

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