W00_024c: User friendly - Alert fatigue - VistA

USER FRIENDLY:
The nurses like the COWS (Computers on Wheels) better instead of the in-rooms. Provider takes time away from the face-to-face interaction. There are clinicians who don't want to do anything with the computer, but they must be motivated to incorporate it on their workflow. It all depends on how user-friendly the program is, because if it takes too much effort to use it, you better change it to an easier one. Programmers and physicians are different kind of people, so programs won't be used if not user-friendly. At University of Virginia, physicians took 6 more hours to enter the info into a CPOE, they went on strike. As technology advances, user-friendliness increases. Pretty soon doctors won't have to type in information, just talk and computers will automatically type it. But the human interaction won't ever go away, for checking the facts.

Errors by omission: you forgot to do something you should have done. Errors by commission: you knowingly did not do something.

ALERT FATIGUE:
About 5 years ago, they computerized everything and the system would tell you the interactions you are not supposed to do. But the computer kept giving alerts when doctors were working, and they were alerts that doctors did not need, so they starting switching off the alerts. That is alert fatigue. What you need to do is discern what should make the alarms go off and what shouldn't.

Technology is 10% of the problem, people is 90%.

Research indicates that with technology, doctors ask more questions and make better decisions, so the level of healthcare improves.

VistA:
Most hospitals went electronic quite a while ago, 10 or 15 years ago. But now we are talking certification, so they might be changing the system. And the hospital has to absorb that cost. These vendor-based systems come at millions of dollars. However, the VA has a free EHR system called VistA. It was created by federal dollars, therefore it is open source or free to whoever wants to use it. Mexico adopted that system, and now it is their only EHR system. And this solved the problem of interoperability. The certification takes away some of those stumbling blocks but there are still problems, which we would not have if everybody used the free VistA system, as in Mexico.