Among the many grand experiments with information technology in health care, two seem especially hot right now: using telemedicine to extend the reach of a limited number of physicians to a greater number of patients and using computerized physician order entry systems to reduce medical errors. This column has looked at both issues this year, but news about each continues to break.

Telemedicine on wheels
In February, Computing Care reported on the Houston-based Memorial Hermann Health System’s adoption of a telemedicine system called the electronic intensive care unit. The multimillion-dollar system allowed just a few intensive care specialists to monitor all intensive care patients. The system involved fitting intensive care rooms with the means for physicians, patients, and nurses to communicate live via audio and video.

It turns out that there is another way to attack the problem. Rather than making every room a telemedicine studio of sorts, a few hospitals are now using roving robots as physicians that can wheel in to visit patients, providing that same audio/visual interface and virtual presence.

A “robo-doc” named Roni is now making rounds in the neuro intensive care unit of the University of California at Los Angeles Medical Center. A specialist can visit with patients and communicate with staff at the unit from any location that has an internet connection and a video camera, simply by driving the robot into a patient’s room. The physician is displayed on a monitor atop the 5-foot-tall robot, and a camera on the robot sends video of the patient back to the physician’s remote screen.

St Mary’s Hospital in London is testing two other robo-docs made by the same company, Santa Barbara, Calif-based InTouch Health. Surgeons who cannot physically be at the hospital are using the robots, nicknamed Sister Mary and Doctor Robbie, to visit with their patients and to deliver lectures and opinions to junior surgeons.

Perhaps if the idea catches on, we’ll someday have robots that make house calls.

CPOE Controversy
A JAMA-published case study caused a huge stir in the healthcare IT world earlier this year (see May’s Computing Care) when it reported that the computerized physician order entry (CPOE) system at a hospital was creating confusion and conditions that could lead to medical errors. This news was unwelcome both to proponents of CPOE software and to people who have been counting on CPOE adoption to result in an unambiguous reduction in medical errors.

Not long after the debate over the JAMA paper simmered down, another study added a little more meat to the stew. The study, published in the May 23 Archives of Internal Medicine, found that over a 20-week period in 2000 in the Veterans Administration’s Salt Lake City Health Care System, 483 “adverse drug events” were reported in 937 admissions and 9 percent of those events (more than four per 100 admissions) resulted in serious harm. The Salt Lake group was using systems for electronic medical records and CPOE, but that software apparently was insufficient to stamp out medical errors.

The researchers’ conclusion? Decision support is a crucial part of the mix: “High rates of ADEs may continue after implementation of CPOE and related computerized medication systems that lack decision support for drug selection, dosing, and monitoring.”

Perhaps more cautionary tales about CPOE await. If so, the default assumption about CPOE systems may be that unacceptable errors still will occur after the systems are installed. The next step will be for the organizations using them to conduct a thorough study to find the causes of persistent errors.

The author of this monthly column, David Orenstein, is a technology and business writer in Silicon Valley. If you have a question about a Computing Care column or to request a future topic, email him at davealli@comcast.net.