TECH: It’s not how big your cross is, it’s where you put it

English comedian Jasper Carrot once did a great election night skit which had a parent explaining politics to a kid in the same way they explain the birds and bees. Hence the line “It’s not how big your cross is, it’s where you put it” (Yes in the UK people just put a cross next to the name on the ballot paper, and the polls stay open way longer, but their electoral results aren’t ridden with fraud….unlike here)

A new article in iHealthbeat by Colleen Egan basically says that same thing about CPOE. Essentially Seattle Childrens and Pittsburgh Childrens both put in Cerner’s Powerchart in their Pediatric ICU. The title is Not Quite the Same: CPOE Studies Using Identical Technology Report Different Results.

Pittsburgh you may recall saw a big rise in infant mortality. Seattle saw a slight drop.

What was the difference? As I said in THCB when the Pittsburgh brou-ha-ha broke, it’s process. Particularly getting the clinicians involved in the implementation and workflow design.

For example, unlike Pittsburgh, Seattle “had active involvement of [the] intensive care unit staff during the design, build and implementation stages,” according to the study. Also, “Both institutions placed a great deal of effort in designing and implementing order sets, but CHP did not have the order sets for the critical care setting available at implementation,” the CHRMC study notes. According to the Seattle study, “implementation issues … rather than inherent issues with the CPOE itself … are the primary risk factors affecting mortality during implementation of CPOE.” Del Beccaro notes that CHP did not have the benefit of extensive previous data or studies to use as a model, so “some of the things they learned were by trial and error.”

That’s no surprise and it goes for virtually every kind of major software implementation—including of course CPOE, as we’ve known from the days of the Cedars-Sinai debacle.


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  1. I have heard it said that it is better to have a bad system well implemented than to have a good system poorly implemented. I think this is a case in point to underline the fact that you cannot just take health IT and throw it at a problem. Health IT improves process, but to do so you must think through the process and find ways your tool can improve it. It takes work and thought…things people don’t always want to do.