Could CPOE increase mortality?

I've been reading up on literature regarding Computerized Provider Order Entry (CPOE) implementation strategies and ran into this article. It's quite old but significant and controversial. When the article was published, it was during a time when CPOE was still very young with relatively little solid data to back it up. This paper from Children's Hospital of Pittsburgh serves as a good case study of how bad things may happen to good technology.

In essence, the hospital retrospectively showed that the unadjusted mortality rate rose from 3.86% pre-CPOE to 6.57% post-CPOE in an intensive care setting. The reasons stated why CPOE didn't work did not seemed like they were issues with CPOE itself, but rather the hospital's infrastructure and work processes.

The article states "[a]fter CPOE implementation, order entry was not allowed until after the patient had physically arrived to the hospital and been fully registered into the system, leading to potential delays in new therapies and diagnostic testing." It's hard to believe the software would do this; was this a tech issue or a policy problem?

Furthermore, they complained that the "...physical process of entering stabilization orders often required an average of ten “clicks” on the computer mouse per order, which translated to 1 to 2 minutes per single order as compared with a few seconds previously needed to place the same order by written form." UI design is very important, but they didn't state the technological "savy-ness" of the user. 10 clicks = 1 to 2 minutes?! I've seen some Twittered-frenzied residents microblog 140 characters faster than I could hand write my own name.

Last, but not least: "Because the vast majority of computer terminals were linked to the hospital computer system via wireless signal, communication bandwidth was often exceeded during peak operational periods, which created additional delays between each click on the computer mouse. Sometimes the computer screen seemed 'frozen.'" That is a hospital infrastructure problem. It has little to do with CPOE; invest in a gigabit router or something.

The paper also admits they trained users for a whole 3 hours before rollout. Ouch.

Thankfully, this paper has largely been de-bunked by reponses much more academic and mature than my own.

via @rxinformatica