IT and liability

As demonstrated previously in our discussion of the T.J. Hooper case (Feb. 2008, p. 56), technology has played a role in the determination of appropriate industry standards since the 1930s.

The Helling case additionally evinced the shift to a "reasonable physician" standard of care, which has since been followed by similar determinations.

In fact, this link is material.

In Vasquez v. Albertson's, a Texas district court jury found a physician negligent for writing an illegible prescription to which the jury attributed the patient's death. The pharmacist, a co-defendant, was held liable for guessing what the doctor had written.

This case established the precedent of physician negligence for illegible handwriting and provides a powerful argument in favor of electronic prescribing.

According to one legal expert, "Handwritten prescriptions should be relegated to the past. Pharmacies should insist on typed prescriptions at a minimum and encourage medical professionals to transmit prescriptions electronically. Physicians and pharmacies will have better records of medications, dosages prescribed and instructions for use. This in turn allows fewer chances for error (and resulting legal liability). Electronic transmission also will facilitate electronic access to prescribed medication records by patients and their physicians."

The Vasquez case demonstrates the salience of this discussion about information technology in medicine; the issue of illegible prescriptions is only one among many potential sources of medical errors.

IT advances in veterinary medicine

While human and veterinary medicine share many similarities, there obviously are many differences to consider, not the least of which is the vast range of patient conformations and physiologies in veterinary medicine.

Both professions treat many similar illnesses and benefit from the same or similar technologies. But significant differences exist between the two professions' ability to finance research and technological progress, as well as clients' willingness or ability to pay for increasingly expensive care.

This lack of resources is a particularly limiting variable in private practices, where the small size of the practice and amount of information technology available and used is considerably less than in human medicine.

The immense growth of the veterinary profession in recent years sparks hope that the margin of difference will continue to shrink, but veterinarians should strive to incorporate what measures are available in the interim.

Unlike human medicine, where there is increased reliance on IT, most private veterinary clinics still record and organize patient data on charts. Banfield is an exception. It uses a computerized information network called PetWare to manage medical records and client accounts for more than 500 hospitals and millions of animals.

The system downloads and provides information on prior visits, precautionary alerts by attending veterinarians, drug dosage recommendations and inquiries for prescribed treatment regimens. As a reference to attending veterinarians, recognized anesthesia protocols are accessible for review prior to a procedure.

The system offers Web-based training programs for veterinarians and clinic staff. PetWare then logs completed training programs for future employee reference. The veterinary profession as a whole can benefit from data gleaned from the system through cooperative research studies.

Individual technologies, particularly the Personal Digital Assistant (PDA) and tablet computer, hold particular promise for the veterinary profession but are perhaps underused in veterinary medicine as clinical resources.

The impact of PDAs in human medicine is already being felt, and as many as 95 percent of physicians are using them for some aspect of patient care. They offer immediate access to stored references for pharmaceutical information, including dose volume and administration, possible drug interactions and electronic means for prescribing drugs. Electronic versions of popular clinical references (including veterinary references) can also be installed for quick access. A non-exhaustive list of such programs available for the PDA include drug indexes, IV drip calculators, blood and fluid volume calculations and medical references, all of which can be stored on expansion cards. PDAs are a relatively inexpensive ($200 to $500) yet important means to reduce potential medical errors and streamline the course of daily clinical practice.

With the advent of technology for wireless modems and a wireless Internet access system, PDAs can send and receive information via the Internet. This has allowed development of systems to link PDAs to hospital medical records, so that clinicians can access up-to-date patient information, as well as electronically prescribe drugs using their PDA.

PDAs work well as vehicles for the CDSSs discussed earlier, as well as other generically labeled "point of care" (POC) medical information systems.

The PDA can prompt, suggest, remind and safeguard against human error. One expert says "Hand-held devices (PDAs and tablet computers) ... have the potential to make patient records and traditional medical and nursing charts obsolete." Such technology need not be limited to doctors; many nurses use them as well.