Computerizing care can have unexpected consequences

The Obama administration is banking on the idea that electronic medical records will reduce errors and costs. But much refining will be needed, at least with computerized drug orders, a University of Pennsylvania study shows.

Penn researchers compared two groups of doctors on their use of two drugs with potentially dangerous interactions: the blood thinner warfarin and an antibiotic, trimethoprim-sulfamethoxazole. To test if a hard-to-override alert would reduce the drugs' use together, the researchers had the system stop those orders for half the users while leaving the old system in place for the others. The computerized "stops" had the desired effect; fewer prescriptions of both drugs together were made by the first group. But the study was stopped early because of four cases in which patients had long delays in getting the needed drugs. Brian L. Strom, who led the study, said that one solution could be to make it easier to override computer stops in patients with HIV and other conditions for which timely administration of the two meds are critical.