Problem: no contraindications

Electronic health care record systems are widely and frequently claimed to reduce injury and death due to prescription errors, since they are able to detect and warn for interactions between products. This claim is largely nonsense, because of the following:

  • Interactions between products are not the only dangerous effects we have from bad prescriptions
  • Interactions aren’t even among the most important dangers
  • Most doctors know of most important interactions and do not generally need these warnings
  • Most warnings we do get from these systems are hilarious or tragic, or plain boring, depending on your mood. They are rarely useful.

Most of these warning systems actually contribute to the danger instead of reducing it, simply because of their existence. It’s too easy for trusting young (or old) doctors to rely on the system to warn for interactions, creating a habit of optimistic prescribing. These users don’t realize how bad these systems generally are, so they adopt dangerous behavior and simply try out prescriptions just to see if they get warnings. If not, they prescribe.

The real problem, however, is contraindications. The presence of certain diseases makes it dangerous to administer certain therapies. A number of classes of medications should not be used if the patient is pregnant or has an enlarged prostate, certain cardiac arrythmias, or glaucoma of the eye, just to name a few examples. Some of these contraindications are deadly and most are hard to remember and easy to miss. But nobody talks about them, since our EHR systems, due to the lack of the concept of “disease” in some form, are totally unable to check for contraindications. Instead, the vendors praise the abilities of their interaction warnings, which in actual fact are near to nothing.

You can find this page on the iotaMed wiki. You can discuss it on Vard IT Forum, where you can find my blog posts published a day or more ahead of time.