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Study Says E-prescription Systems Would Save At Least 50k Lives a Year

samzenpus posted more than 2 years ago | from the take-a-green-pill dept.

Medicine 134

First time accepted submitter shirleylopez1177 writes "Approximately 50,000–100,000 people die in America because of preventable adverse events (PAE). These PAEs or medical errors are among the leading causes of death, ranking higher than breast cancer, AIDS and motor vehicle accidents in terms of the number of fatalities caused. As a response to the problem of medication errors, e-prescription systems have emerged. Few studies have looked at how e-prescribing systems compare to traditional systems in their potential to reduce medical errors. However, a study from Australia published two weeks ago in PLoS Medicine examined the impact of e-prescription systems on medication errors in the inpatient setting and demonstrated that these systems are indeed effective."

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10 years ago... (5, Interesting)

goathumper (1284632) | more than 2 years ago | (#39098897)

I worked on a hospital system 11 years ago that would provide this sort of cross-referencing functionality. It always baffled me why their use wasn't widespread. Back then there were (evidently) no smartphones, etc, so the whole idea of having barcodes on patients' wrists was revolutionary, as was the concept of having computer systems perform the drug-to-pathology matching and medication interactions analyses.

From what I learned working on that project, this sort of system can lower the costs of operation, staffing, and evidently lower risk inside a hospital. Does anyone out there know why they've not seen widespread adoption (besides the "obvious" tin-foil hat doctor-nurse-conspiracy theories)?

Re:10 years ago... (0)

Anonymous Coward | more than 2 years ago | (#39098961)

inertia.

Re:10 years ago... (4, Insightful)

Anonymous Coward | more than 2 years ago | (#39099187)

inertia.

No - cost.

Hospitals have strict budgets and have to penny pinch. The software vendors charge a ludicrous amount for their software - so much that the hospital admins cringe and have a very hard time finding the money. And with these hard times, hospital revenues are in a huge slump - all those unemployed people have lost their health insurance and therefore can't pay their hospital bills - which the hospitals eat much of it. (COBRA is obscenely expensive and if you have a "preexisting" condition, you can't get cheaper insurance or any insurance for that matter; so millions of people go without even when they can afford health insurance.)

To head off the "software vendors have to worry about lawsuits and that's why they charge so much!"

No they don't. They have no more product liability costs than any other company and as far as FDA requirements, they've actually reduced some of the regulation. [fda.gov]

Re:10 years ago... (1)

cmarkn (31706) | more than 2 years ago | (#39099265)

This opens an area where open-source software ought to be able to make an enormous impact, saving both money and lives. But who would adopt it, regardless of how little the liability of the developer? The doctors, hospitals and pharmacists would have their lawyers tell them to try to protect themselves even that infinitesimal amount by avoiding it.

Good open sources software exists (2)

sgent (874402) | more than 2 years ago | (#39099563)

in the public domain. VISTA is the Veteran Administration's EMR which has generally gotten very good reviews by physicians. However, it is an unbelievably archaic on the back-end (uses M, predates relational databases, etc.). In addition there is no emphasis on charge capture, so it often is useless for billing purposes.

Re:10 years ago... (4, Interesting)

AngryDeuce (2205124) | more than 2 years ago | (#39099229)

Very much this. Doctors are notorious for being stuck in their ways, especially as concerns administration and computerization. My step-mother actually just quit her administration job at a small practice a few days ago because they were still doing everything on paper; she said she hadn't worked in an office with that minimal level of technology in almost 20 years.

Especially now as doctor's "margins" are getting thinner due to Medicare cutbacks and such, I'm sure this trend will continue. New tech costs money, and medical tech, even on the administration end, is ridiculously expensive.

Re:10 years ago... (3, Insightful)

timeOday (582209) | more than 2 years ago | (#39099939)

Especially now as doctor's "margins" are getting thinner due to Medicare cutbacks and such, I'm sure this trend will continue. New tech costs money, and medical tech, even on the administration end, is ridiculously expensive.

I think the opposite: private practices are being driven out of business by large hospitals [nytimes.com] that work closely with insurers (including digital records), and more doctors are becoming employees instead of small business owners. In other words, price pressure is asserting itself and forcing consolidation, like with every other industry. Good or bad? I'm not entirely sure. We certainly do need to cut costs. There won't be many mom-and-pop shops that refuse to move to computer records any more.

Re:10 years ago... (3, Interesting)

genjix (959457) | more than 2 years ago | (#39099941)

3 years ago I damaged my elbow. I went to see the hospital, and the nurse being too busy to hear my full story hurried me along telling me it was sprained. I knew what a sprained elbow felt like and this wasn't it, but I shrugged my shoulders and assumed it would get better. It's been aching on and off over the last few years.

A physician on the bitcoin forums was offering medical advice for a bitcoin. I typed up my full story and sent it to him. He wrote me back a long response that quite literally scared the crap out of me into seeing a doctor. I took his write-up to my General Practioner and she right away knew what was wrong and referred me to all the relevant specialists.

That guy on the bitcoin forums literally saved me from crippling injury in a few years time. Had I not spoke to him, it may have been too late before I got it checked out. I always kept putting it off since I'm so busy and it didn't seem like a big deal.

Thank you bitcoin forum guy.

Bitcoin whore (3, Funny)

nairnr (314138) | more than 2 years ago | (#39100843)

Thank you for your bitcoin advertisement. Now to return back to reality.

Re:10 years ago... (2, Informative)

SteelKidney (1964470) | more than 2 years ago | (#39098991)

I expect that reading the Daily WTF ought to answer your question. Or Diebold's attempts to use whatever legal maneuvers they could in order to cover up the fact that they were selling extremely poor-quality software. Or the fact that Sony got so thoroughly and completely pwned over the past couple of years that it's not unreasonable to assume that anything more complicated than "Hello World" written by a Sony team is yet another hack waiting to happen.

Re:10 years ago... (0)

Anonymous Coward | more than 2 years ago | (#39099177)

Or the fact that aviation code was written by VB monkeys, or that space probes run read-only perl code, or that... ehmm...

The *REAL* reason for pushing "e-prescription"... (0)

Anonymous Coward | more than 2 years ago | (#39100579)

Put on your tinfoil hat real tight now....you might really need it this time.

The real reason for the push is so that the government can more easily track down to the nit picky detail what all ailments and treatments that every individual in the nation has. They intend to farm this data, not only for more control over our personal lives, but to look for certain specific trends. There is coming the day when even over-the counter drug sales... yes even NSAIDS and cough syrup sales will tracked in detail down to the individual. This is so that they can better detect that whenever someone has the beginnings of something really bad, like cancer and exhibits a sudden increased self-medication with OTC pain meds because he realizes that the new nationalized health care system will deem him to be uneconomic for proper treatment (e.g. the patient is an unemployed 55-yr old white male former construction worker with only high school education versus a 30-something yr old college professor) and because of this, the patient intends to stay out of the nationalized healthcare system altogether, the government wants to be able to early-detect these cases and single out that 55-yr old redneck since he'll know that he will get the shaft in the government medical system, and since he's approaching old age and death anyway, the government fears that he will much more likely "twist off" and commit an act of domestic terrorism against the government.

Sincerely,
Dale Gribble

Re:10 years ago... (0)

Anonymous Coward | more than 2 years ago | (#39099163)

Does anyone out there know why they've not seen widespread adoption (besides the "obvious" tin-foil hat doctor-nurse-conspiracy theories)?

Basic human psychology. People in general don't like to pay money to avoid risk. There's an interesting branch of economics that deals with this.

Re:10 years ago... (1)

cmarkn (31706) | more than 2 years ago | (#39099297)

Don't tell your insurance agent that. I think you have it backwards: the main, and possibly only, reason people spend money is to avoid risk.

Re:10 years ago... (1)

shaitand (626655) | more than 2 years ago | (#39099673)

The only insurance agents I have are the ones that are forced on me. Insurance companies make money because the odds are against receiving more money than you pay them. It doesn't matter what kind of insurance it is or how big the payouts.

People spend money on things, they want some tangible good or service for their dollars with obvious value. The obvious exception is the wealthy and financial institutions who spend the bulk on their money on investments, but they are on the side of insurance company, they are the casino not the gambler despite all their efforts to cloud the issue.

Re:10 years ago... (1)

Anonymous Coward | more than 2 years ago | (#39099713)

Prospect theory, dude. Kahneman got a Nobel for it. Humans are less likely to pay to avoid risk of loss than they are to secure gains, even if mathematically it should be the same thing. The curve is asymmetric. (Simple version: ask n people if they would take a sure loss of $10 or flip a coin for a possible loss of $20 and a possible loss of $0. Then ask n different people the same thing, except with a gain rather than a loss. The "loss" group will overwhelmingly select the coin toss, the "gain" group will overwhelmingly select the sure thing.).

Now, that doesn't mean you never pay to avoid risk, just not as often as a theoretical "rational economic actor" would.

(And my insurance agent already knows that I carry the minimum required vehicle insurance that my state allows me to hold).

Re:10 years ago... (1)

K. S. Kyosuke (729550) | more than 2 years ago | (#39099179)

I worked on a hospital system 11 years ago that would provide this sort of cross-referencing functionality. It always baffled me why their use wasn't widespread.

Because non-tech people usually don't understand the "computer is a universal tool" thing and have problems stretching the limits of their imagination ("I had no idea a computer could do that for me...")

Re:10 years ago... (1)

QuantumRiff (120817) | more than 2 years ago | (#39099239)

The problem is, there are only 2 groups that seem to provide these databases.. Neither are cheap. I am sure there is a LARGE amount of liability for developing such a database..

Re:10 years ago... (2)

goathumper (1284632) | more than 2 years ago | (#39099291)

The interesting thing is that the whole system had been proposed and led by doctors. They knew the benefits and seemed to actively want them. Perhaps most crucially: the system didn't take doctors out of the loop - humans could still override the computer's warnings/indications/whatnot as necessary (obviously this would be well-audited).

I agree that the risk of replacing humans with technology is still there. And yes - hacks are always possible as long as humans are in the mix of creating the computerized system. However, even if it lowers the number of fatalities due to PAEs by half, it would be a huge win money-wise for insurance companies, etc. (which begs the question: why hasn't it been done on that basis alone? We all know ca$h makes the world go round...) - despite the risk of hacks or tampering.

Just sayin'... maybe we should build a F/LOSS platform for this so that it can be widely audited and its quality can be more transparently verified... volunteers?

Before Windows Vista there was... (3, Informative)

tepples (727027) | more than 2 years ago | (#39099379)

maybe we should build a F/LOSS platform for this so that it can be widely audited and its quality can be more transparently verified

Can you code in MUMPS [wikipedia.org] ?

Re:10 years ago... (0)

Anonymous Coward | more than 2 years ago | (#39099969)

Perhaps most crucially: the system didn't take doctors out of the loop

(Posting AC because) I work on medical records and e-prescription software. Number one complaint with our software's e-prescription system? The doctors DO NOT WANT TO BE IN THE LOOP. They piss and moan about how they miss the days when their nurses could just phone in refills of controlled substances (totally illegal) without bothering them (also illegal). They whine that the computer makes them fill out the prescription themselves (even with one click to prescribe the same thing they prescribed for the last person with whateverdiddlyosis) instead of handing a blank pad to the nurse to handle it with a signature stamp (absolutely illegal).

I'm sure they are more than happy to do whatever they can to prevent being sued for malpractice... as long as they can have the PA do it for them.

Re:10 years ago... (4, Insightful)

demonlapin (527802) | more than 2 years ago | (#39100529)

I'm a physician whose hospital just tried to push all orders onto electronic order entry - not just medications but diet orders, PT/OT/nursing orders, everything. It got massive pushback. Why?

Most doctors see patients at more than one hospital. Many use an electronic system at their clinic. They have to remember five or six usernames, passwords, and different ways of doing things, any one of which is likely to change at any time due to an upgrade, and some of which they may not use for months (as an example, many surgeons maintain privileges at a wide variety of hospitals to be able to suit patients - but they may not operate at a given one for two or three months at a time). The interface is often clunky. And they're SLOW. Paper is FAST.

Great example from a committee meeting last week: one endocrinologist is part of a group that has taken over management of difficult diabetic inpatients. Most of them have Medicare, or Medicaid, or nothing at all. From his perspective, he's getting paid very little for his work. On paper, he can check blood sugars, write an order, and move on to the next patient in about two minutes. On computer, the same process takes about five minutes. Thirty patients an hour versus twelve... and so he said that if he's forced to do electronic, he will just stop doing the difficult diabetic management. It's no longer worth his time.

And, as others have said, these systems are fantastically expensive, and so while there are some savings to be reaped they are mostly taken by the vendor and the increased IT expenses. And then your vendor decides to EOL your software... what do you do then? Buy their replacement product, because it's a lot cheaper to stay with the same vendor? Buy a new whole-hospital system from another vendor? We're wrestling with that now.

Re:10 years ago... (0)

Anonymous Coward | more than 2 years ago | (#39100651)

I've worked in software development on projects related to this for over 15 years, so I can offer some observations:

1) Pharmacology is unbelievably complicated. Pharmacists must have a PharmD degree (Doctor of Pharmacy) to practice. Even with several pharmacists as domain experts it's very difficult for the programmers to understand what they're writing. Use an expert system? Yea, right.

2) Say what you will about Big Pharma, they are constantly introducing new drugs, updating interactions and allergies, etc. The entire domain is a rapidly moving target.

3) There aren't very many customers out there who will buy the product. If you sell ten or twenty installations a year you're doing good. And each installation is extraordinarily complicated (see #1 and 2 above)

4) Physicians want the modern system, but they also know that when a system like that is put in place there is always a rash of errors and people die. How many patients are you willing to sacrifice to bring up a new system? And most doctors really hate killing their patients.

i just dropped (0)

Anonymous Coward | more than 2 years ago | (#39098963)

my e-prescription because the system was horked - doc could never get thru, scripts went unfilled, no connection between on-line status and reality, on-line gui blew monkey chunks...

NHS e-Prescribing (2, Insightful)

Anonymous Coward | more than 2 years ago | (#39098967)

Here in the UK, system like this are in use in both General Practice and in Hospitals. I worked for a company for seven years that supplied software that did precisely this to NHS and private hospitals both here an abroad. I wonder how the stats compare between the UK and the USA in this regard?

Re:NHS e-Prescribing (1)

ledow (319597) | more than 2 years ago | (#39099553)

Whether it exists doesn't correlate to whether it's used.

My girlfriend had an argument with her doctor only the other week because he hand-filled out the prescription, gave it to his medical receptionist, who took it upon herself to post it to the local Tesco's (whose pharmacy staff really are a waste of space) without ever asking.

The Tesco's couldn't fulfil it so she had to fight to get the paper prescription back, take it to Boots herself (who could only fulfil half of it, and did so without asking first, and kept her paper prescription telling her she could collect the other half "next month" - when this was supposed to be an out-of-cycle prescription so she could take her medication on a long holiday that would mean she'd normally miss her prescription filling date).

Some places might have them, but for sure nowhere near all, or even most. And to be honest, there's an awful lot of problems with them that they can't cope with that even getting humans to cope with can be tricky (obstinate cows in your local GP's reception office aside).

Are we out in the middle of the sticks? No. Greater London, major town. Similar experiences with the same things in other parts of London and Essex, too. We're a long way from any automation. I know, I sat and read through my entire medical records a few years back because they're still in the same envelope (that I can recognise amongst all the others), still the same pieces of paper, and still have to be pushed by post/courier to every doctor I deal with (fortunately, I hardly deal with doctors at all in the last 10 years unless something is dropping off...).

Re:NHS e-Prescribing (0)

Anonymous Coward | more than 2 years ago | (#39100071)

I agree. Several years ago I took a script for a topical steroid to a pharmacy. Told me they would not fill it at the previous advertised price because the new price was 400% higher. I argued and they argued and the manager finally gave me a sample for free. I calmed down, thanked them and asked for the script back because it had several refills and they refused. Said it was illegal because I had already received meds. Would not take back the sample. This really actually honestly happened. The entire cost of the doctor's visit was wasted and the script was never filled as I walked out cursing loudly. I even contacted their corporate head who replied and said such a thing should have never happened and he would look into it. Never heard back and never went back. Imagine what will happen with escripts. Imagine you need a life saving drug and pharmacy A has the script at 500% the cost of pharmacy B. You have to pay pharmacy A to transfer the script to pharmacy B.

The solution, according to the summary? (1)

knifeyspooney (623953) | more than 2 years ago | (#39098973)

Stick an e- in front of it. Magic!

Re:The solution, according to the summary? (4, Interesting)

gmack (197796) | more than 2 years ago | (#39099095)

If the doctor could log in and select the medication and have the pharmacy read the prescription it would, on it's own, prevent a lot of errors that happen from misreading prescriptions. On top of that, if there is something wrong that requires a specialist then the patient is in a fun place where no one doctor knows what all medications are prescribed so a system that did any sort of automated conflict checking could save a lot of lives.

The current system is far from perfect, I once almost lost my job because some pharmacist misread my prescription for Singulair (Asthma med) and gave me an antipsychotic instead and for a week I couldn't be motivated to do anything.

Better solution (1)

Dcnjoe60 (682885) | more than 2 years ago | (#39099777)

If the doctor could log in and select the medication and have the pharmacy read the prescription it would, on it's own, prevent a lot of errors that happen from misreading prescriptions. On top of that, if there is something wrong that requires a specialist then the patient is in a fun place where no one doctor knows what all medications are prescribed so a system that did any sort of automated conflict checking could save a lot of lives.

The current system is far from perfect, I once almost lost my job because some pharmacist misread my prescription for Singulair (Asthma med) and gave me an antipsychotic instead and for a week I couldn't be motivated to do anything.

A better solution would be that if the pharmacy cannot read the prescription, then they don't fill it. It should be the doctor who has the responsibility to make sure that what he/she is ordering is clear and understandable, not their receptionist or some clerk at the pharmacy. Doctors should be held accountable for prescription mistakes that are caused by their own haphazard penmanship.

Re:Better solution (1)

ColdWetDog (752185) | more than 2 years ago | (#39100469)

A better solution would be that if the pharmacy cannot read the prescription, then they don't fill it. It should be the doctor who has the responsibility to make sure that what he/she is ordering is clear and understandable, not their receptionist or some clerk at the pharmacy. Doctors should be held accountable for prescription mistakes that are caused by their own haphazard penmanship.

Exactly that. The pharmacist needs to be talked to in a manner that will get their attention. If you don't understand something, get it checked out.

This, however, is the main reason for an e-prescribing system - not the interactions (the database sucks, way too many false positives). But there are literally thousands of drugs out there and names can be annoyingly similar. Decimal place errors can be a big problem as well. You need the information presented in a clear UNAMBIGUOUS fashion. Only way to do that, save for using a typewriter [wikipedia.org] (link provided for all of you young'ins out there) is a computer.

Re:Better solution (1)

need4mospd (1146215) | more than 2 years ago | (#39100751)

Or an even better solution, check the name of the drug prescribed to you with the label on the container before taking it! My doctor has ALWAYS said, "I'm prescribing this for you, take X amount per day." I check the note he gives me and I check the bottle when I pick it up. I even check to make sure the pills inside match the description given in the documentation. If people are involved, mistakes WILL be made. The pharmacist reading it off the computer can misread it, accidentally grab the wrong bottle, put the wrong dose on the label, etc... Even the doctor could accidentally type/click something wrong! No solution will be 100% error free.

Not that I don't fully support a technological solution, but personal responsibility has to come into play when you're doing something that affects your health.

Re:The solution, according to the summary? (1)

Black Parrot (19622) | more than 2 years ago | (#39099205)

Stick an e- in front of it. Magic!

That's so Twentieth Century. Now you have to stick an i- in front of it to make it cool.

Re:The solution, according to the summary? (1)

dkleinsc (563838) | more than 2 years ago | (#39100003)

By your logic, then, IE is the coolest magical product ever!

Stop over prescribing? (0)

Anonymous Coward | more than 2 years ago | (#39098975)

Nah, not gonna work - too much greed in the system.

You heathen technocrats! (3, Insightful)

fph il quozientatore (971015) | more than 2 years ago | (#39099005)

How dare you replace a competent, well-trained, warm-hearted human with an emotionless machine?

Re:You heathen technocrats! (1)

K. S. Kyosuke (729550) | more than 2 years ago | (#39099213)

The emotionless machine at least will never glare at you for trying to get attention.

mod dowN (-1)

Anonymous Coward | more than 2 years ago | (#39099011)

any7hing can [goat.cx]

No (0)

Anonymous Coward | more than 2 years ago | (#39099041)

Approximately 50,000–100,000 people die in America because they relies too much on prescription drugs.

Nowhere else on the planet do people take that many drugs in those quantities.

Re:No (1)

Forty Two Tenfold (1134125) | more than 2 years ago | (#39099079)

Approximately 50,000–100,000 people die in America

WHICH America? North or South?

Re:No (0)

Anonymous Coward | more than 2 years ago | (#39099131)

North America is best America.

Re:No (1)

Capt. Skinny (969540) | more than 2 years ago | (#39100475)

[The United States of] America

Re:No (2)

19thNervousBreakdown (768619) | more than 2 years ago | (#39099141)

Approximately 50,000–100,000 people die in America

WHICH America? North or South?

--
"You can always count on Americans to do the right thing - after they've tried everything else." - W. Churchill

WHICH America? North or South?

Re:No (2)

hrvatska (790627) | more than 2 years ago | (#39099515)

WHICH America? North or South?

The America that people around the world generically use to refer to the United States of America. It might have something to do with America being the largest word in the country's name. When Iranians chant 'death to America', they're referring to the USA. Not Canada. Not Brazil. Not Mexico. Just the USA. Everyone gets this reference except people who have to ask 'WHICH America? North or South?' They're so fucking dense they go around wondering if Iranians want death for all countries in the Americas or just in North or South America. Maybe if Canada, Mexico, Brazil, Argentina, or any other major country in the Americas had America in its name there might be some confusion. But they don't, and there isn't.

Re:No (1)

WrongMonkey (1027334) | more than 2 years ago | (#39100779)

You should try travelling south of your border sometime. Pretty much everyone else in the western hemisphere would consider it at least slightly offensive to imply that 'America' refers exclusively to los Estados Unidos

Re:No (1)

shaitand (626655) | more than 2 years ago | (#39100243)

Contrary to popular southern belief America hasn't been divided into North and South since the end of the civil war.

Re:No (1)

secretsquirel (805445) | more than 2 years ago | (#39099149)

north, but not canada or mexico

Re:No (1)

Anonymous Coward | more than 2 years ago | (#39099381)

WHICH America? North or South?

Neither.

I know that this is hard for some people to understand, but let me spell it out again, as simply as I can. In the most common usage:

North America is a continent.
South America is a continent.
America is a country.

I know that this reality may not seem logical to some of the overly literally-minded people around here, but too bad. Much of the English language and its common idioms don't make literal sense. Deal with it.

Are all deaths equal? (0)

Anonymous Coward | more than 2 years ago | (#39099043)

One thing I've wondered about is whether we should consider all deaths equal. Is it as tragic if an 80 year old dies from a presecription error as if a two-year old dies in a car crash? From the perspective of life span, the 80 year old likely got cheated out of 7-10 yeas of life but the 2 year old around 70.

My intuition tells me that a disproportionate number of these 50k deaths are individuals who are older or who are very sick to begin with. Comparing the # of deaths with breast cancer might not be the best way to compare.

Having said that I have been using E-prescription systems for a couple of years and I love it. Seems easy for the doctor, for me and for the pharmacy...

Re:Are all deaths equal? (1)

schnikies79 (788746) | more than 2 years ago | (#39099171)

If they are preventable deaths, yes they are equal.

Re:Are all deaths equal? (1)

demonlapin (527802) | more than 2 years ago | (#39100559)

Morally, yes. Financially, no.

Re:Are all deaths equal? (1)

vlm (69642) | more than 2 years ago | (#39099227)

One thing I've wondered about is whether we should consider all deaths equal. Is it as tragic if an 80 year old dies from a presecription error as if a two-year old dies in a car crash? From the perspective of life span, the 80 year old likely got cheated out of 7-10 yeas of life but the 2 year old around 70.

My intuition tells me that a disproportionate number of these 50k deaths are individuals ... who are very sick to begin with.

Your numbers are way too high. Taking, say, my grandmother into consideration, depending on the prescriptions selected, some years ago she had the choice of dying of heart/circulatory trouble, lung trouble, or kidney trouble. Technically the doctors may have made the "wrong" off the cuff under fire multidimensional optimization thus robbing her of hours, perhaps even days of life. Not 7-10 years. As an engineer, I think they did pretty well, but I can see how someone brought up with rich Dr always right on pedestal above us all never wrong might want to file a malpractice lawsuit for those couple hours of life in exchange for what they think will be a big financial payoff. Or, a deal where you guys are trying to bill a uninsured widower for $2M of "service" but we will "overlook" the malpractice if you "overlook" the $2M bill. Etc.

Ditto the kid. So my son had horrible flu and pneumonia (and eventually made a 100% recovery thanks) but in the ER they had to decide to risk hard core IV antibiotics that he might be allergic to vs fluid in lungs vs high fever needing IV (whatever it was) to drop his temp which also has side effects, etc. Now if they had guessed wrong and he croaked, VERY superficially you might claim he lost 70 years of life, but lets be realistic, a semi-dehydrated little kid with the flu and a high fever and trouble breathing, without any medical intervention his lifespan would have been, what, maybe a day or two at most? Certainly not 70 years. A kid that sick in Africa would be dead for sure.

Re:Are all deaths equal? (2)

neapolitan (1100101) | more than 2 years ago | (#39099347)

You two have a good understanding of the tradeoffs involved with decision-making. Unfortunately, many people do not and see suboptimal outcomes as "errors" in a very black-and-white world. I think the IOM report fed into many fears.

I am continuously annoyed about the IOM report -- as other posters have said, it is now out of date, and sensationalist IMO in the way it counted mistakes and deaths / errors. An "error" that had no effect in a critically ill patient who died 3 days later was counted as a fatal outcome. On the other hand, the sensationalism at the time might have been a bit warranted -- doctors are often very complacent and perhaps the attention was needed / desired to get large scale action. However, it had the side effect of the erosion in trust in those that work very hard, diligently, and conscientiously every day.

I very, very rarely use handwritten prescriptions. Certainly as inpatient (patients who are currently in the hospital) essentially all major medical systems have computer order entry as of 2012. In my outpatient clinic (people just coming for a doctor appointment) it is 100% computer medical scripts with automatic interaction and allergy checking. All of my hospital system is this way.

I can't remember ever having ANY medication or dosing error. Obviously I can't know about it if I don't catch it, but computer order entry, automatic checking, and the many layers of check from doctor, nurse practitioner, pharmacist, and nurse, (and patient!) does provide a safety net.

Can we do more? Well, banning handwritten prescriptions would be a pretty bad idea (if I'm in a community clinic wanting to give a patient some antibiotics for an ear infection, I think I should be allowed.) There are side effects to every initiative. Encouraging computer use is indeed being done, but limited by cost concerns.

Re:Are all deaths equal? (1)

vlm (69642) | more than 2 years ago | (#39099681)

...sensationalist IMO in the way it counted mistakes and deaths / errors. An "error" that had no effect in a critically ill patient who died 3 days later was counted as a fatal outcome.

Yikes, so you're saying a gunshot wound bleeding out who doesn't get a required tetanus shot would be counted?

Can we do more? Well, banning handwritten prescriptions would be a pretty bad idea (if I'm in a community clinic wanting to give a patient some antibiotics for an ear infection, I think I should be allowed.)

I have not ready any /. comments about fraud / prescription abuse, what do you think about that WRT to handwritten vs e-prescriptions? Fraud w/ paper is harder to detect (or is it?) and when it happens I would assume thats one order at a time, whereas online I'd assume if you get owned you'll suddenly insta-prescribe 100000 orders of some abuse drug. You could design systems for both paper and online that are either secure or insecure, I'm sure paper has been optimized and electronic has not been optimized as much...

Re:Are all deaths equal? (1)

demonlapin (527802) | more than 2 years ago | (#39100627)

The tetanus shot would be tracked as a quality measure rather than a med error, but yes, that's actually how most of this stuff works.

At least in my state, you must hand write prescriptions for controlled substances on a fraud-resistant pad (the sort that can't be photocopied).

Re:Are all deaths equal? (1)

ColdWetDog (752185) | more than 2 years ago | (#39100755)

The IOM report did grade error severity - they're not that dumb. The press, as usual, didn't pick up on that nuance. The IOM report, however, didn't do a very good job of grading error severity. In particular, it did not look at any metric like quality-adjusted-years-of-life that would balance a small error made in an elderly terminal patient. That was likely intentional since the thrust of the report was to say 'hello! Beuhler! wake up!'. Subtleties can come later.

Unfortunately for US medicine you have an enormous, many tiered complex system with numerous stakeholders with often competing interests simultaneously spending a significant fraction of the GNP while running out of money. Makes it hard to change things on a system wide basis which is exactly what we need to do - it's not just tossing a computer into the mix as computerizing chaos usually just yields computerized chaos.

Re:Are all deaths equal? (1)

shaitand (626655) | more than 2 years ago | (#39100353)

One could take your argument the other way though. A two year old doesn't even have significant brain function yet, they haven't done anything for society, they haven't learned any skills, so they worth much. The 80 year old has 80 years of experience and learning and probably has children, grandchildren, a spouse, assets, and in many cases a fully functioning brain to recognize them all so they've earned their ten years.

Personally I'd value an 18-30 yr female at a much higher rate than either. 18+ yr old males who are not me or tasked with serving me in some way we can kill off.
 

The begin of the article misleads... (5, Informative)

Troyusrex (2446430) | more than 2 years ago | (#39099065)

by implying that drug errors are causing 50,000 to 100,00 deaths a year when, in fact, drug issues are a very small portion preventable adverse events (PAE). Things like falls and catheter infections are far more common. The article mentions that drug allergies and cross drug reactions are already extremely low and unaffected by implementing e-prescription (probably because the computers in the pharmacy already alert to this). The only thing effected are illegible prescriptions. I think e-prescriptions are a fine idea but this article is misleading as to how much benefit it would have in terms of lives saved.

Re:The begin of the article misleads... (0)

Anonymous Coward | more than 2 years ago | (#39099107)

Agreed! I think it's shameful that people give doctors a free pass for being so sloppy in their work. I also think it's shameful that a pharmacy would fill a prescription they cannot plainly read and/or do not fully understand. It comes down to no caring enough aboutyour job, and no electronic system is going to fix that.

Re:The begin of the article misleads... (1)

Capt. Skinny (969540) | more than 2 years ago | (#39100601)

I also think it's shameful that a pharmacy would fill a prescription they cannot plainly read and/or do not fully understand

Personally, I think it's shameful that a patient would ever hand over a prescription without understanding what drug they a being prescribed, or would take pills from a bottle without reading the label to verify what drug it is.

Re:The begin of the article misleads... (1)

dstates (629350) | more than 2 years ago | (#39099153)

Agree. The IOM study cited in the article is more than a decade out of date and there are many causes of preventable adverse events. In some respects, electronic order entry systems actually confound the allergy and adverse reaction problem because comments about allergies accumulate and are never reviewed. An elderly patient may have mentioned a decade ago that they were "allergic" to some medication because they got a headache after they took it, but once that allergy is on the drug allergy list, no one is going to put themselves on the line and delete it. As a result, the lists of drug allergies tend to accumulate junk over time and may prevent physicians from using the most appropriate medication.

Re:The begin of the article misleads... (2)

vlm (69642) | more than 2 years ago | (#39099393)

An elderly patient may have mentioned a decade ago that they were "allergic" to some medication because they got a headache after they took it, but once that allergy is on the drug allergy list, no one is going to put themselves on the line and delete it. As a result, the lists of drug allergies tend to accumulate junk over time and may prevent physicians from using the most appropriate medication.

Amoxocillian makes me puke, at least it did once 30 years ago. Or maybe I puked after amoxocillian because I was home from school and ate nothing but junk food because I was sick and miserable. Fast forward 30 years and horrible ear infection from my ear infected kids, go to doc, amox worked great on the kids but I can't have it. Doc suggests something and warned me of horrific side effects (was it cipro ?). I talked him off the ledge and we agreed zithromycin would be safer and more appropriate. 4 hours later the fever was gone, feeling better, etc. Even azithromycin is not harmless. The "best" answer probably would have been amox and don't eat any taco bell or other upsetting substances, but that is not possible for insurance reasons, etc.

You don't want to get in a situation where you have a relatively minor headache, but aspirin gives you a slight tummy ache, so they "have to" do exploratory brain surgery instead. I can imagine an old person being "allergic" to everything and therefore getting crazy treatment plans that are much riskier than a minor reaction.

When I was in the army my Drill Sergent "forced" everyone with a red allergy dog tag to find out what their reaction was, not just that they were allergic as a simple binary yes/no. He had some story about being in central america with a buddy with a minor leg infection and the corpsman only had antibiotics on hand that his buddy was allergic to, so they were contemplating cutting his leg off vs how bad would the allergy reaction be. Supposedly option 3 medivac saved both his life and leg...

Re:The begin of the article misleads... (1)

ColdWetDog (752185) | more than 2 years ago | (#39100833)

The most common mis diagnosis in American medicine is 'Penicillin Allergy' (which would generally include amoxicillin). For exactly the reasons you cite. Actually, most EMRs do have some ability to at least explain the interaction. If I saw "Amoxicillin Allergy - nausea" on your chart, I would ask the circumstances and quite likely might prescribe it, especially if you were willing to 'experiment'.

There is a test for true penicillin allergy that's reasonably safe but requires some expertise so is usually done by Allergists or their ilk. We don't utilize it enough. It is often much easier to just label someone 'allergic' and go trundling on. But it can come back to bite you.

My favorite line is 'my mother thinks she is allergic to penicillin so I am too'. Logical thinking for the win!

Re:The begin of the article misleads... (2)

Rich0 (548339) | more than 2 years ago | (#39100041)

Agreed. A big problem is that often there is only a binary allergic/not-allergic list.

My wife has been to the hospital numerous times and I end up going through the allergy list when she is unable to do so. Half the stuff on the list raises eyebrows because they are medications that she regularly takes. I explain to them that she isn't allergic to them, but that she does have sensitivities that should be considered (lower does, extended-release, avoid if possible, etc). They end up leaving them on the allergy list since they don't know what else to do with them. I try to talk to the doctors often so that they're in the loop, and usually the stuff on the list is more for chronic treatment so it isn't as big a deal.

They really need to have lists that include what actually happens. If a drug makes you really sleepy or nauseous it is a completely different situation than if it causes anaphylaxis. However, I've seen doctors try to get my wife to take a drug in the hospital that we know makes her nauseous when she is already nauseous, and we already know that an extended-release formulation works better for her (but the hospital didn't have it handy). Things like that make me tend to micro-manage the nurses and account for every pill she gets, so that red flags like that can be escalated (especially when it just involves me running home to grab a bottle of pills and have the pharmacy ID it).

I've also spotted cases where nurses try to administer drugs that doctors had intended to stop, despite having electronic everything already implemented (obviously the doctor forgot to update the orders). Again, being present I can have them bug the doctor and get it straightened out.

There has to be some way to cut down on odd mistakes like these. Often they don't turn out to be serious, but they do often prolong a stay and add expense. Plus, you're far more likely to develop some complication from a 5 day stay than a 2 day one (I've had to deal with hospital-induced issues like heart failure, anemia (from thinners), and general loss of sleep/etc). Delays get compounded when a missed order doesn't get caught until you end up waiting another day (patient took a pill that had to be stopped pre-procedure, or some test is booked up, or whatever). In fact, I'd say that 90% of the time I've seen in the hospital amounts to ordering tests at 8AM one day, and then reviewing results and ordering more tests at 8AM the next day. If they just checked the results when they were available you'd cut out half-days of latency all over the place.

Re:The begin of the article misleads... (2)

Another, completely (812244) | more than 2 years ago | (#39099225)

I saw an article a few years ago that gave a great comparison. Sorry I can't find the reference, but at the time it said your chance in a hospital of getting the wrong medication ("wrong" defined as not what you were prescribed; never mind unnoticed conflicts and so on) was higher than the chance on a commercial flight of having your luggage lost. Some of those are certainly from illegible prescriptions or poorly labelled units, but I bet more are from procedural mistakes.

Still, electronic prescriptions sound like a good idea for everyone concerned.

Too Optimistic (1)

cmarkn (31706) | more than 2 years ago | (#39099089)

This won't prevent all events, only those caused by pharmacists being unable to read hand-written prescriptions. There will still be those resulting from doctors misremembering the name of the medication or a pharmacist grabbing a wrong bottle. No doubt it would save a lot of lives, but most of those would be saved by simply typing prescriptions instead of hand writing them.

Along the same line, however, there is a ridiculous amount of paper being faxed between doctors and between doctors and insurance companies that should have been eliminated long ago and replaced with email. I talk to people that do this, and they use the all-in-one machines to print both kinds of paper, but can't seem to comprehend the similarity of the two media. Perhaps the use of a secure method of communication, such as encrypted email, would finally replace faxes. Someday, even lawyers might accept the technology.

Re:Too Optimistic (2)

Geraden (15689) | more than 2 years ago | (#39099159)

Not true!

While human error like you describe above certainly exists, these systems can also catch drug allergy interactions, drug-to-drug interactions, and even food-drug interactions. Along with the already-existing systems in most pharmacies, these systems provide another layer of protection for patients. They also provide doctors with real-time best-cost analyses, allowing them to prescribe the most effective, least expensive drugs based on a patient's particular drug coverage. This may help to lower the overall price of healthcare and insurance coverage.

Protection from the errors you describe isn't technologically insurmountable, either. Robotic systems that are linked to the prescription and automatically fill prescriptions eliminate the pharmacy errors, and EMRs that provide diagnosis/drug checking are likely right around the corner. Doctors don't like the latter much, however, because they are perceived as taking too much of the medical process out of their hands.

Re:Too Optimistic (1)

Dcnjoe60 (682885) | more than 2 years ago | (#39099825)

Robotic systems that are linked to the prescription and automatically fill prescriptions eliminate the pharmacy errors, .

Assuming that the human who filled the bins that the robot uses to fill the prescriptions didn't make a mistake. There is always a human element involved and usually it is cost prohibitive to eliminate it entirely.

Already in use? (1)

0100010001010011 (652467) | more than 2 years ago | (#39099091)

Where isn't this in use? My GP can order a prescription from is computer in the room. Same goes for any hospital, etc I've been in. The only thing that requires the actual script is scheduled drugs because it's (theoretically) harder to forge.

I'm leaving Slashdot (-1)

Anonymous Coward | more than 2 years ago | (#39099093)

Hi, I'm Anonymous Coward and I've been posting to slashdot from the very beginning.

However you lot have just become too fucking old. You've lost your idealism, and become shitty old men, which is why I'm moving to Reddit.
At first I was concerned by the lack of editors, but it's not like the editors here are worth a damn, and the new censorship system is just unacceptable. The mod system doesn't even go up to 11.

Well, it's been fun but fuck you all. And your mothers,
Good bye sirs.

Inadequate summary. Sigh. (2)

Ronin441 (89631) | more than 2 years ago | (#39099113)

The summary (mostly) included one of the two key facts:

each year approximately 50,000–100,000 people die in America because of [...] medical errors

But not the other:

implementation of e-prescription systems resulted in an approximately 60 percent reduction in total medication-error rates, and a 44 percent decrease in serious medical errors

So the expected improvement is 22k to 44k less deaths per year in America.

Re:Inadequate summary. Sigh. (1)

Black Parrot (19622) | more than 2 years ago | (#39099349)

The summary (mostly) included one of the two key facts:

each year approximately 50,000–100,000 people die in America because of [...] medical errors

But not the other:

implementation of e-prescription systems resulted in an approximately 60 percent reduction in total medication-error rates, and a 44 percent decrease in serious medical errors

So the expected improvement is 22k to 44k less deaths per year in America.

If the summary is correct (not a given!), there are 50,000-100,000 total PAEs. But only a fraction are going to be prescription-related, so the number of lives saved is probably much lower.

Re:Inadequate summary. Sigh. (1)

Dcnjoe60 (682885) | more than 2 years ago | (#39099923)

If the summary is correct (not a given!), there are 50,000-100,000 total PAEs. But only a fraction are going to be prescription-related, so the number of lives saved is probably much lower.

Exactly right. While the discussion seems to be focused on the wrong medication being dispensed or even drug interaction, it is far more common that the correct medication, but at the wrong dosage is dispensed. Dosage errors are not going to be picked up by an e- system.

Medication errors != deaths (2)

nbauman (624611) | more than 2 years ago | (#39099591)

Just because they made an error, that doesn't mean a death resulted from the error. A patient's blood pressure may have shot up or down for a day, but (unacceptable though it is) they might have caught it and it might not have harmed him.

Even more effective... (1)

Geraden (15689) | more than 2 years ago | (#39099115)

Disclaimer: I work in the field, but am NOT associated with any particular vendor.

Even more effective than stand-alone eRx systems are Electronic Medical Record systems with integrated eprescribing. The ability to better track & manage patients' problems longitudinally provides for much better care and better outcomes.

I recognize that there are, however, some fairly major privacy concerns....many of which still exist at the ePrescribing level. Let's face it, if a system knows what you're taking, it doesn't take huge logical leaps to deduce your underlying conditions.

Re:Even more effective... (1)

Black Parrot (19622) | more than 2 years ago | (#39099257)

I recognize that there are, however, some fairly major privacy concerns....many of which still exist at the ePrescribing level. Let's face it, if a system knows what you're taking, it doesn't take huge logical leaps to deduce your underlying conditions.

Hey, maybe I take that Viagra for my acne!

Re:Even more effective... (1)

Waffle Iron (339739) | more than 2 years ago | (#39099511)

it doesn't take huge logical leaps to deduce your underlying conditions.

If we had a sane healthcare system in this country, nobody would care what conditions you might have.

As it happens, in the current US system healthcare coverage is inexplicably all entangled together with your employment. So your boss, (the one party that you would probably be least happy knowing about your health status) not only knows all about it, but is also in a position to cut you off from both your income and your healthcare coverage.

Re:Even more effective... (1)

supercrisp (936036) | more than 2 years ago | (#39100781)

Clearly you are a pinko. Embittered smart-assery aside, I know several people, and I'm one of them, who have delayed treatment or consultation with a doctor for fear of acquiring a "pre-existing condition." In my case, I have had symptoms of prostate cancer for several years, but I kept putting off diagnosis because I was on the job market and feared losing coverage of any treatment I might need. Now that I have a decent job, and that I've been tested and received a negative diagnosis, I look back and think about how stupid I was back then. But I'm not back then anymore. I'm still the same relatively smart and mildly paranoid person I was back then. I know two others who are currently delaying diagnosis while they seek jobs, for conditions not so serious as cancer, but both with serious pain and performance implications. And they're smart people too. I'm hoping someone will reply to this and say that we're misinformed, that there's some protection for people in that spot. But I don't think that is the case. (I'm not hoping, but I know that someone will post below saying that what I want is not health "insurance" but "socialized medicine." Okay. I do. So what? I've spent a ton of money and a lot of time getting myself educated, and the government has spent a metric fuck-ton on my education; I'm worth keeping alive and functional. Socialize me, baby!)

Title assumes... (1)

JoeMerchant (803320) | more than 2 years ago | (#39099123)

Article title assumes e-Prescription systems will solve most problems of the current system.

If rolled out into wide deployment, e-Prescription systems will have a lower success rate than they currently do in the hands of people who want them.

If abused with contempt, e-Prescription will perform worse than current systems, though if implemented with fidelity, the e-system could at least point a finger at the weak link in the chain, if anyone cares enough to analyze the records and develop witch hunt reports.

Just yesterday... (2)

orphiuchus (1146483) | more than 2 years ago | (#39099143)

I got some shit advice from the medical staff at my university. I'm taking a drug called celexa and got a cold, not wanting any adverse interactions I called them up and asked what medicine it was OK for me to take. Coricidin Cold and Cough they said, was the safe choice.

I Googled it before I went to the store and found a major interaction via drugs.com. A potentially fatal interaction. Super.

Re:Just yesterday... (1)

geogob (569250) | more than 2 years ago | (#39099269)

That's exactly the kind of mistake that leads to such high mortality figures. I couldn't believe it as i read the summary and on. I never would have thought PAE related mortality would be so high in the US.

But even the best system can't compensate for human incompetence and laziness. In your case, you either got someone on the line who had no clue and too lazy to either refer you to someone who had one or check it up or to someone really incompetent. Even the best electronic tracking system wouldn't have helped in your case. At least not for drugs sold over the counter. For prescription drugs, a centralized system tracking your prescriptions would rise a flag at the pharmacist preparing the prescription, even if you get wrong advise from other medical professionals along the line.

Anyone, we often tend to forget that doctors are not experts in medication. The only know so much. Pharmacist and pharmacologist are the reference in this field... they are the one we should ask question regarding medical interaction.

Doctors vs. Pharamcists (1)

swb (14022) | more than 2 years ago | (#39099569)

Anyone, we often tend to forget that doctors are not experts in medication. The only know so much. Pharmacist and pharmacologist are the reference in this field... they are the one we should ask question regarding medical interaction.

I don't take a bunch of medicines, but my experience has been pretty consistent that doctors don't spend a lot of time talking about medication or dose, but pharmacists are very reluctant to question prescription-related decisions by doctors (eg, this medicine vs. another, dosage, etc) unless its an outright, PDR-printed contraindication.

Pharmacy in the US, at the level most people are exposed to it, seems to be one of those occupations that exists because of laws regulating controlled substances -- ie, you have to be a licensed pharmacist to dispense them. The pharmacy board and the professional associations make sure enough laws are processed that no company can dispense medication without having one on site, even though pharmacy techs seem to do the bulk of the work.

You almost wonder if the system wouldn't be better if a doctor's office employed a pharmacist; you meet with them after the doctor if a drug is prescribed. The pharmacy would just be a place to physically obtain the medicine.

It might cut costs, too, since a pharmacy open 14 hours a day could probably shave $200,000 a year in salary and benefits. That's an easy billion a year for walgreens alone.

Re:Doctors vs. Pharamcists (1)

geogob (569250) | more than 2 years ago | (#39099829)

The pharmacist and the doctor are not competitors in the world of the best advice. They are two professional, each having their field of expertise. They have to work together to give the best possible treatment to the patient.

If either sees questioning of some advice as negative, then there is a fundamental problem - and this is where reform needs to start. Of course, working together does imply taking the time to talk to each other when problem arise.

I lived most of my life in Canada, and if my pharmacist wasn't certain about some strange posology on the prescription or spotted a possible interaction, he didn't unilaterally decided otherwise. He called and consulted with his colleague, the doctor, who wrote the prescription. This is how it should be done. And it's not just in Canada. Now I live in Germany, a country that has a radically different medical system structure. The same way, if a problem arise with a prescription, the pharmacist will contact the practician to discuss the issue and identify proper alternatives.

Maybe I was just lucky always to have good pharmacists?! But this is pretty much how I picture how this system should work. Of course, the information about other drugs you are taking won't come automatically to the pharmacist. Without a centralized tracking system, he'll only know what you tell him.

Re:Just yesterday... (2)

vlm (69642) | more than 2 years ago | (#39099427)

Coricidin Cold and Cough they said, was the safe choice.

The new stuff made from chlorpheniramine or the old stuff made from psudephedrine?

Thats the "killer" with brand names.

Re:Just yesterday... (0)

Anonymous Coward | more than 2 years ago | (#39099437)

it's not a major interaction, drugs.com is overstating it. Not to mention it's going to be very dose dependent on the 2 drugs. If you're taking 10 mg celexa vs 80 mg yadda yadda. A lot of cautions have been recently added to high dose celexa of late.

Point is...electronic interaction checking stuff like drugs.com is limited. They don't take all the factors into account and there is simply not data to give them to decide what is and isn't risky. Is there a study checking what doses of celexa mixed with DM can cause serotonin syndrome? Probably not one that can be used to calculate how risky taking them together is. In practice, people do it all the time though and are fine.

In regards to E-prescriptions, if it hasn't been mentioned, it's just as easy for the doctor to click the wrong button as it is to write like crap. I can attest that there are insufficient safety measures in that regard as it seems to happen a lot. Probably still better than nonsense writing. There should be checks when e-prescribing of the medication they are choosing vs the patient history as they put it in, ie if the doctor clicks on midrin and the patient has been on midodrine, it RED FLAGS them angrily. Or something like that. I suppose that would do nothing to stop errors with new meds though.

Save lives, yes, but one question... (0)

Anonymous Coward | more than 2 years ago | (#39099173)

How will it make money for the insurance and pharmaceutical companies?

Sure, those treatments may be costly, but ever thought that killing people reduces their expenses? You know their accountants are working out the odds.

More seriously, or perhaps even more conspiratorially, there will be people who think this is part of some massive intrusion into their life, and a clear violation of their personal privacy, and fight it tooth and nail.

That's why the US doesn't have EHR. Too many people don't want it.

Re:Save lives, yes, but one question... (1)

Black Parrot (19622) | more than 2 years ago | (#39099279)

More seriously, or perhaps even more conspiratorially, there will be people who think this is part of some massive intrusion into their life, and a clear violation of their personal privacy, and fight it tooth and nail.

It's no conspiracy! I know a guy who knows a guy who has an e-prescription, and they deliver his drugs at night with Black Helicopters!

Also, caused autism in his nephew's dog.

We have this in Estonia (2)

Reigo Reinmets (1035336) | more than 2 years ago | (#39099197)

We have this e-prescription system in Estonia for over 2 years now, nation wide. The good - It's easier to get some recurring prescriptions that you have to take all the time, you just calle the doctor and say you are running low on the meds, he checks your previous prescriptions and can easily see that yes, you should have only a few left... (to detect you are not attempting to scam extra medicines for black market or something). Also another good thing is that combined with an electronic pharmacy database, you can check online exactly which pharmacies currently have this medicine in stock in the right quantity(My partner takes meds that come in 10, 20, 30, 50 and 100mg forms, She only wants the 100mg ones). The bad - Initially they had performance problems because they forgot one basic simple thing when calculating peak usage - All elderly / pension receiving people(They are also the ones who require a lot of prescription medicines.) get their pension on the same day in the beginning of the month. This gives them a reason to leave the house and go to the city, and most of them also buy their medicines within the 2 days period following it, causing a massive performance bottle-necks for that moment(This problem was later fixed by adding more servers + optimizing).

Pharmageddon (-1)

Anonymous Coward | more than 2 years ago | (#39099215)

http://articles.mercola.com/sites/articles/archive/2011/10/26/prescription-drugs-number-one-cause-preventable-death-in-us.aspx

http://articles.mercola.com/sites/articles/archive/2011/02/04/death-by-medicine-an-update.aspx

Even properly prescribed & properly administered drugs are still a bad idea in general (with a few exceptions) because they can't even identify, (much less remove), the true root cause of the disease. NOBODY has a deficiency of any drug! They purposely disrupt body functions to remove a symptom, not a cause.

Galatians 5
19 Now the works of the flesh are manifest, which are these; Adultery, fornication, uncleanness, lasciviousness,
20 Idolatry, witchcraft, hatred, variance, emulations, wrath, strife, seditions, heresies,
21 Envyings, murders, drunkenness, revellings, and such like: of the which I tell you before, as I have also told you in time past, that they which do such things shall not inherit the kingdom of God.
22 But the fruit of the Spirit is love, joy, peace, longsuffering, gentleness, goodness, faith,
23 Meekness, temperance: against such there is no law.

In verse 20, the word "witchcraft" comes from the Greek word "pharmakeia", which means "the preparing or using of medicine; then, the using of any kind of drugs, potions, or spells;" Therefore, by definition, this includes both legal & illegal drugs. They will always be dangerous because they are all categorized as works of the flesh instead of fruit of the spirit.

This same word is used in Revelation 18:23 translated "sorceries" here.
23 And the light of a candle shall shine no more at all in thee; and the voice of the bridegroom and of the bride shall be heard no more at all in thee: for thy merchants were the great men of the earth; for by thy sorceries were all nations deceived.

"Thy merchants were the great men of the earth". This refers to people who are born of the seed of the serpent(satan) and have a huge amount of control over the world. They always promote drugs because the love of money is the root of all evil. Drug companies & drug lords are making hundreds of billions of dollars every year and are deceiving entire nations as a consequence!

My Doctor's System Hates My Pharmacy's System (2)

Jonah Hex (651948) | more than 2 years ago | (#39099277)

And I hate them both! I have tried to make use of the CVS pharmacy automated refill system, but from what I can tell the "automation" goes into a blackhole and requires manual intervention. The system the doctor pushes is to fill out a form on their website, but from what I can tell it just generates a phone call from them to the pharmacy... sometimes. For me it is a major hassle, especially since my drugs are not considered "maintenance" prescriptions and have limits on getting insurance to cover mutli-month supplies. - HEX

Re:My Doctor's System Hates My Pharmacy's System (3, Funny)

zindorsky (710179) | more than 2 years ago | (#39099833)

And I hate them both! I have tried to make use of the CVS pharmacy automated refill system

You should try the SVN or HG systems instead.

Overoptimistic claim (1)

Anonymous Coward | more than 2 years ago | (#39099301)

Not every medical error that causes death is a prescription error, so helpful as this system may be, it probably won't save quite as many lives as advertised.

Leave a loophole (1)

concealment (2447304) | more than 2 years ago | (#39099371)

Since our society currently does not allow assisted suicide, please leave a loophole so doctors can prescribe fatal overdoses of morphine or other painless life cures. Terminal patients, people in vegetative states and miserable suicide-prone Goths everywhere will thank you.

It is interesting to me how almost Goedelian any set of rules can be. We always need to leave exceptions, or we strap ourselves into a Catch-22 (mixed with Brave New World) maze of rules that eliminate the finer points of decision making.

Largest problem is Multiple Docs, one Patient (1)

cbelt3 (741637) | more than 2 years ago | (#39099581)

My wife works in Assisted Living. She's had many situations where residents have shown signs of mental or physical degradation because of medication interactions. Not because one doctor prescribed interacting drugs, but because separate doctors prescribed interacting medications. The multi-specialist medical industry assumes that the patient is a medical expert, and can keep track of their medications AND know the interactions. All responsibility is in the hands of the patient. And guess what ? Most of us did NOT get medical training.

So a central clearinghouse system that red flags things isn't a bad idea. Most health insurance companies do it now anyway.. why ? Because they'd rather not pay for medication issues.

There's of course a darker reason... finding people who are 'doctor shopping' to enable their abuse of prescription drugs. The more centralized data is, the easier it is for a well meaning government to abuse that data for some sort of control. So...

do you REALLY want all your medications to become a public record (because we all know governments stink at privacy and security) ?

A final aside... some patients need medications that interact. My wife takes two medications that potentially interact. She's been taking them for years. But suddenly she 'cannot' because there 'is a risk'. Automating this refusal would deny patients who depend on these interactions for survival. Coding medical procedures is always a bad idea, because there has to be an exception process that involves actual human beings.

1,000-2,000 deaths a week? (1)

kenh (9056) | more than 2 years ago | (#39099613)

I'm not sure, but that claim that this is the leading cause of death in America seems a bit, uhm, off. I suspect there are some broad qualifications to that statement, like leading cause of preventable deaths?..

Interesting it didn't make this CDC list of causes of death: http://www.cdc.gov/nchs/fastats/lcod.htm [cdc.gov]

From the report:

Heart disease: 599,413
Cancer: 567,628
Chronic lower respiratory diseases: 137,353
Stroke (cerebrovascular diseases): 128,842
Accidents (unintentional injuries): 118,021
Alzheimer's disease: 79,003
Diabetes: 68,705
Influenza and Pneumonia: 53,692
Nephritis, nephrotic syndrome, and nephrosis: 48,935
Intentional self-harm (suicide): 36,909

In Canada (0)

Anonymous Coward | more than 2 years ago | (#39099617)

We have a system developed here in Canada that is Open Source. www.oscarmcmaster.org [oscarmcmaster.org] has all of the information about the project and www.oscarcanada.org [oscarcanada.org] is the download location.

Preventable Adverse Event: (1)

vikingpower (768921) | more than 2 years ago | (#39100231)

Slashdot addiction.

It is no panacea. (1)

140Mandak262Jamuna (970587) | more than 2 years ago | (#39100417)

I was talking to my cousin who is a doctor. They have this new fangled iPad based prescription system. Its user interface has been designed by programmers for programmers. As usual they had this wonderful idea to offer edit boxes with drop down auto completion options. (Yeah, it is going towards "got the right Bob?" gmail extension). She completed a prescription, had a nagging suspicion that the down click did not register and the first prepopulated suggestion has been posted. But the form has vanished, no confirmation screen, no quick way to go back and check what she has just prescribed. She browsed hard found the prescription, it was wrong as she had suspected, cancelled it and re-entered the right one.

The moral of the story is, it aint no panacea. It will remove a bunch of current errors, but create a new set of errors

I asked her to demand that the drop down auto complete suggestion box to be populated with the Logo of the drug, not just the name in text, also a confirmation window to pop up and stay on top off all windows for two to three seconds. The confirmation window should, display prominently the drug logo in correct color, based on the dosage picture of a baby/boy or girl/ small man or woman/ big man or woman, the picture of the organ that will be affected by drug. Pretty soon the doctors will develop a mental image of what the confirmation screen should look like and if anything is wrong, a simple "touch anywhere to cancel" action.

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