Cedars-Sinai doctors cling to pen and paper

By Ceci Connolly

updated 3:20 p.m. ET March 21, 2005

LOS ANGELES - It was a dirty little secret among the nurses. A veteran physician at the prestigious Cedars-Sinai Medical Center here had been mixing up a certain drug dosage for decades.

Every time he wrote the prescription for 10 times the proper amount, a nurse simply corrected it, recalled Paul Hackmeyer.

Then the computers arrived -- and when the doctor typed in his medication order, the machine barked at him. And he barked back.

"He thought the computer was screwing up," said Hackmeyer, an obstetrician-gynecologist who did not want to identify his embarrassed colleague. "What we discovered was that for 20 years he was writing the wrong dose."

For proponents of electronic medical records, the tale of the confused physician would seem the perfect argument for using technology as a safety net for fallible humans. Instead, his reaction proved to be emblematic of an array of problems that grew into a full-blown staff rebellion in the fall of 2002 and forced Cedars-Sinai to shelve its $34 million computer system after three months.

Cautionary tale
For every doctor, nurse and executive here, there is a different explanation of what went wrong. The technology, created in-house, was clunky and slow. Only a fraction of the 2,000 doctors with privileges at the hospital were involved in developing the system, even though they faced a dramatic change in the way they practiced medicine, from jotting notes on a clipboard to logging onto a computer to type in their treatment and medication orders. Training was insufficient, and administrators opted for what Hackmeyer called a "big bang" implementation rather than switching one ward at a time.

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Now, two years later, the hospital often viewed as an industry leader is being held up as a cautionary tale in the drive toward bringing medicine into the computer age, and officials here say they have no intention of trying again for at least a year.

The marriage of information technology and medicine is all the rage in health policy circles. Five years after the Institute of Medicine issued a landmark report cataloguing the life-and-death consequences of medical errors, corporate leaders, politicians and physicians are embracing computer-assisted health care.

Sen. Hillary Rodham Clinton (D-N.Y.) and former Republican House speaker Newt Gingrich (R-Ga.) tout it as a tool for improving safety and quality. Employers, desperate to rein in soaring medical bills, are pressing doctors and hospitals to use computers to reduce costly mistakes. And President Bush has asked Congress for $125 million for computerized patient safety projects this year.

"Most industries in America have used information technology to make their businesses more cost-effective, more efficient and more productive," Bush said in a recent visit to the Cleveland Clinic. "The truth of the matter is, health care hasn't."

Difficult transition
Yet the spectacular failure at Cedars-Sinai -- described by Bush's technology guru as "the worst case" he has seen -- demonstrates how difficult it can be to make the transition. Even well-financed, sophisticated hospitals face enormous hurdles moving from the Marcus Welby era of pen and paper to one in which doctors spend precious minutes entering data into a machine that never went to medical school and does not have the flexibility to make nuanced judgment calls.

"First and foremost, it was change," said nursing chief Linda Burnes Bolton. By January 2003, at a heated showdown with management, several hundred doctors demanded an end to the hospital's short-lived experiment.

"The important lesson of the Cedars-Sinai case is that electronic health record implementation is risky," David J. Brailer, national coordinator for health information technology, said in an interview. "Up to 30 percent fail."

Today, about 6 percent of hospitals nationwide have computerized systems for doctors' orders. Ironically, the rationale for introducing information technology is also one of the primary reasons the transition is so difficult, he said.

"You are moving from a freewheeling environment -- which is why there are a lot of errors -- to very controlled processes" that often do not account for creativity, instinct and judgment, he said. "It changes the way everyone interacts."

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