Re: Order up!

Issue: BCMJ, vol. 56, No. 5, June 2014, Page 218 Letters

I was happy to read [Dr Richardson’s] March editorial (BCMJ 2014;56:73) last week—I am seriously behind on my reading. I was beginning to think I was the only one in Fraser Health who wasn’t convinced that computerization is the solution to all our problems. Of interest to you might be an article published in the May 2009 issue of the Journal of the American College of Surgeons.[1] It is the only article I have found that looked at what happened to a physician’s time and workload when a physician order-entry system was introduced. Because hospitals and health regions don’t pay for a physician’s time, there is no incentive for them to develop or introduce a system that saves us time and work. The prevailing attitude is that technology in action is always better than any current system—a system that has evolved and adapted over the years and works very well. Even in the US, where they are pretty brutal about firing and laying off excess workers, there were no cost savings or safety improvements with the introduction of the system.

I am only a semi-Luddite, but like you I can’t see how the one or two computer terminals are going to accommodate the 10 or 12 physicians doing rounds at any one time between 7 a.m. and 9 a.m. Maybe they are going to introduce a reservation system. I have never seen a business plan for EHR implementation and, as you have rightly pointed out, no one is going to have their job eliminated to fund the system. As far as I can see, it is simply a huge amount of money being spent on administrative matters while clinical funds dry up.

On a related subject, you might find an article in the 13 March 2014 issue of the New England Journal of Medicine[2] also of interest. Checklists have been the—and I mean the—linchpin of the culture of safety that administrators have been pushing on us. In short, there was no difference before or after the checklist, despite the significant amount of money and time invested in the introduction and use. Do you want to bet that the science will be ignored because the safety industry would be out of business?
—Norman Causton, MD
Chilliwack


References

1.    Stone WM, Smith BE, Shaft JD, et al. Impact of a computerized physician order-entry system. J Am Coll Surg 2009;208:960-967; discussion 967-969.
2.    Urbach DR, Govindarajan A, Saskin R, et al. Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med 2014;370:1029-1038.

. Re: Order up!. BCMJ, Vol. 56, No. 5, June, 2014, Page(s) 218 - Letters.



Above is the information needed to cite this article in your paper or presentation. The International Committee of Medical Journal Editors (ICMJE) recommends the following citation style, which is the now nearly universally accepted citation style for scientific papers:
Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.

About the ICMJE and citation styles

The ICMJE is small group of editors of general medical journals who first met informally in Vancouver, British Columbia, in 1978 to establish guidelines for the format of manuscripts submitted to their journals. The group became known as the Vancouver Group. Its requirements for manuscripts, including formats for bibliographic references developed by the U.S. National Library of Medicine (NLM), were first published in 1979. The Vancouver Group expanded and evolved into the International Committee of Medical Journal Editors (ICMJE), which meets annually. The ICMJE created the Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals to help authors and editors create and distribute accurate, clear, easily accessible reports of biomedical studies.

An alternate version of ICMJE style is to additionally list the month an issue number, but since most journals use continuous pagination, the shorter form provides sufficient information to locate the reference. The NLM now lists all authors.

BCMJ standard citation style is a slight modification of the ICMJE/NLM style, as follows:

  • Only the first three authors are listed, followed by "et al."
  • There is no period after the journal name.
  • Page numbers are not abbreviated.


For more information on the ICMJE Recommendations for the Conduct, Reporting, Editing, and Publication of Scholarly Work in Medical Journals, visit www.icmje.org

BCMJ Guidelines for Authors

Leave a Reply