Computers for Physicians: Never Do Harm

Abstract

will prescribe regimens for the good of my patients according to my ability and my judgment and never do harm to anyone.-Hippocratic OathThe thesis of this article is that as physicians-including those who work with the older adults-adopt new technologies, we have an ethical obligation to focus on doing good for our patients and avoiding harm. In 2008, only 17% of U.S. physicians used electronic medical records (EMRs; DesRoches, 2008). There are many reasons why physicians are reluctant to use computers, including difficulty evaluating new technology, the time required to manage such systems, confidentiality of patient records, fear of malpractice, the U.S. fee-for-service payment system, high costs, and immature technology. Nevertheless, in 2009, the American Recovery and Reinvestment Act allocated $29 billion over 10 years for physicians to use certified EMRs (Blumenthal, 2011). In addition, for the last half century, computer technology has improved at exponential rates, following Moore's Law. For instance, in 2011, Apple introduced the iPhone 4S with its voice recognition digital assistant called Siri. Now, as money and technology accelerate, geriatricians will feel increasing pressure to adopt EMRs.ASSUMPTIONThis article is built on the assumption that a geriatrician can improve patient outcomes. This was the theme of the Institute of Medicine's To Err is Human (Kohn, Corrigan, & Donaldson, 2000). Now, the U.S. government hopes to fill these gaps in the quality and efficiency of health care by using computer technology (Blumenthal, 2011). The benefits of technology include alerting physicians to patient's anaphylactic allergies, offering point-of-care information about drug dosing for older adults, recalculating the dose for patients with hepatic or renal failure, introducing new clinical guidelines, notifying about drugs recently withdrawn from the market, analyzing drug-drug interactions, and expanding a doctor's differential diagnosis. However, technology is not a panacea, and physicians, as leaders of U.S. health care, have an obligation to avoid technology that harms patients. Thus, when we adopt new technology, we must use the same thoroughness that we use to vet new drugs. Even medical devices have more U.S. government oversight than health information technology (HIT; Crosse, 2011).PURPOSEThe purpose of this article is to find ways for geriatricians to evaluate technology. The goal is to find technology that makes meaningful improvements in patient outcomes and does no harm. This purpose will be fulfilled by addressing the following questions:1. What will happen if the HIT crashes or disappears? How shall we protect our patients from harm?2. How do we handle confidentially when patients and their family send us e-mail?3. Who created the software? Are all data clearly attributed to particular authors and dated? Are these authors trustworthy?4. How does the technology help us when we are uncertain about how to take the next step for a patient?5. How old is the technology and when will it be updated?6. Is the technology easy to use?7. How does this technology help us communicate with other physicians in our health care center?For each of these questions, we will consider a case history about a patient harmed by technology from my experience. Second, we will review the advantages and disadvantages of the technology. Third, we will study reports from the literature about similar harms. Fourth, we will state guidelines to evaluate whether technology will improve patient outcomes without causing harm. Finally, we may include advice on how to avoid harm in the future.CASE HISTORIESSystem CrashesQuestion 1: What will happen if the HIT crashes or disappears? How shall we protect our patients from harm?Case: At the VA on a sunny Sunday morning in Florida, I was 1 hour into my 12-hour shiftwhen the computer system crashed throughout the hospital. …