Press releases Saturday 15 May 2004

Please remember to credit the BMJ as source when publicising an article and to tell your readers that they can read its full text on the journal's web site (http://bmj.com).

If your story is posted on a website please include a link back to the source BMJ article (URL's are given under titles).

(3) WEB TECHNOLOGY CAN HELP CHRONICALLY ILL PATIENTS

(4) E-PATIENTS ARE A VALUABLE RESOURCE

(Prescribing safety features of general practice computer systems: evaluation using simulated test cases)
http://bmj.com/cgi/content/full/328/7449/1171

(Commentary: computer aided prescribing leaves holes in the safety net)
http://bmj.com/cgi/content/full/328/7449/1172

Computer prescribing systems are putting patients at risk by failing to warn of potentially serious errors, warn researchers in this week's BMJ.

The NHS Information Authority regulates the use of general practice computer systems, but these contain only general references to safety and there is evidence that they do not prevent contraindicated prescribing.

Researchers in Edinburgh, Kent and Nottingham tested four computer systems currently in use in about three quarters of UK general practices. All of them failed to detect known prescribing errors, especially where drugs were contraindicated.

One solution to this problem is to have more explicit regulations about when suppliers should implement alerts, say the authors. This would require regular dialogue between suppliers and users.

Many of the problems uncovered could be resolved, and this work is now being undertaken by the National Patient Safety Agency, they conclude.

Although computers can reduce medication error rates by as much as 60%, patients still die from the remaining errors, writes an expert in an accompanying commentary. But timely and relevant warnings will prevent disaster.

Hospital systems already exist that link patient history, laboratory results, and prescribing data and that present a hierarchy of warnings to inform, and occasionally forbid the prescriber to continue.

"Those who walk the therapeutic tightrope in general practice will want the assurance of a safety net that will catch important errors before they harm patients, an assurance that current systems cannot provide," he concludes.

Contacts:

Paper: Anthony Avery, Professor of Primary Health Care, Division of Primary Care, University of Nottingham, UK
Email: tony.avery@nottingham.ac.uk

Commentary: Robin Ferner, Director, West Midlands Centre for Adverse Drug Reaction Reporting, City Hospital, Birmingham, UK
Email: r.e.ferner@bham.ac.uk

Nick Rigg, Senior Communications Officer, The National Patient Safety Agency, London, UK
Email: nick.rigg@npsa.nhs.uk

(2) WHAT MIGHT OUR HEALTH SYSTEMS LOOK LIKE IN 2020?

(Four rules for the reinvention of health care)
http://bmj.com/cgi/content/full/328/7449/1197

· Doctors and machines will be "connected" to each other to share knowledge

· Health service brokers will help consumers identify where the best care can be found

· Evidence interpreters will help consumers make informed choices

· Avoidable error will be a thing of the past

These are just some of the innovations that could shape our health services in 2020, according to an article in this week's BMJ.

Over the next 20 years, national health systems will have to treat proportionately more people, with more illness, using relatively fewer tax dollars and workers, yet these systems are already under significant strain.

To flourish in this setting, we must design new systems of care that are fundamentally sustainable, and this may require nothing less than the reinvention of health care, argues Professor Enrico Coiera from the University of New South Wales.

This journey to reinvent healthcare begins by recognising that health systems are "sociotechnical" systems, where people and technologies interact, he writes.

He proposes four rules, based on this thinking, which could help guide the active design of our health services.

If health care is to evolve at a pace that will meet the needs of society it will need to embrace this science of sociotechnical design, but ultimately it is our culture's beliefs and values that shape what we will create and what we dream, he concludes.

Contact:

Professor Enrico Coiera, Centre for Health Informatics, University of New South Wales, Sydney, Australia
Email: e.coiera@unsw.edu.au

(3) WEB TECHNOLOGY CAN HELP CHRONICALLY ILL PATIENTS

(Patients' experience with a diabetes support programme based on an interactive electronic medical record: qualitative study)
http://bmj.com/cgi/content/full/328/7449/1159

Web based programmes can fill an important gap in how health care is currently provided for patients with chronic medical conditions, finds a study in this week's BMJ.

Current healthcare systems, with their focus on the clinic visit, do not meet the needs of many patients with chronic conditions.

Researchers designed a web based diabetes support programme for patients at the University of Washington that included access to their medical records, secure email with their care providers, and interactive disease management tools. Patients were interviewed about their experiences before and after they used the programme.

Patients felt valued and less limited in the care they sought from providers after using the programme. They also felt safer having access to their personal health information.

However, patients were also disappointed when the programme did not work as they expected. This suggests that web based programmes may have particular challenges in fufilling some patients expectations in comparison to traditional visits to the doctor, say the authors.

"Our work supports further study of web based disease management programmes," they write. "In particular, our study shows the importance of early and candid discussions between patients and providers about what a web based programme can and cannot deliver."

Contact:

Joan DeClaire, Center for Health Studies, Group Health Cooperative, Seattle, Washington, USA
Email: declaire.j@ghc.org

(4) E-PATIENTS ARE A VALUABLE RESOURCE

(Editorial: The first generation of e-patients)
http://bmj.com/cgi/content/full/328/7449/1148

Many patients say that the medical information and guidance they can find online is more complete and useful than they receive from their clinicians, according to an editorial in this week's BMJ.

The authors argue that "a major system upgrade" in our thinking is needed, in which e-patients are recognised as a valuable resource that could provide sustainable healthcare solutions.

About half of adults in the United States have looked for health information on the net, yet many clinicians underestimate the benefits and overestimate the risks of online health resources for patients, write Tom Ferguson and Gilles Frydman.

Reports of patients coming to harm as the result of online advice are rare, whereas accounts of those who have obtained better care, averted medical mistakes, or saved their own lives are common.

Medical online support groups have also become an important healthcare resource, while the net friendliness of clinicians and provider organisations is becoming an important new aspect of health care quality, they add.

E-health researchers should realise that we are witnessing the most important techno-cultural medical revolution of the past century, say the authors.

They conclude: "Something akin to a major system upgrade in our thinking is needed. A new cultural operating system for health care in which e-patients can be recognised as a valuable new type of renewable resource ? managing much of their own care, providing care for others, helping professionals improve the quality of their services, and participating in collaborations between patients and professionals."

Contacts:

Tom Ferguson, Senior Research Fellow, Pew Internet and American Life Project, Austin Texas, USA
Email: doctom@doctom.com

Gilles Frydman, President, Association of Online Cancer Resources, New York, USA
Email: gfrydman@acor.org

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