Forgot your password?
typodupeerror
Medicine

Study Says E-prescription Systems Would Save At Least 50k Lives a Year 134

Posted by samzenpus
from the take-a-green-pill dept.
First time accepted submitter shirleylopez1177 writes "Approximately 50,000–100,000 people die in America because of preventable adverse events (PAE). These PAEs or medical errors are among the leading causes of death, ranking higher than breast cancer, AIDS and motor vehicle accidents in terms of the number of fatalities caused. As a response to the problem of medication errors, e-prescription systems have emerged. Few studies have looked at how e-prescribing systems compare to traditional systems in their potential to reduce medical errors. However, a study from Australia published two weeks ago in PLoS Medicine examined the impact of e-prescription systems on medication errors in the inpatient setting and demonstrated that these systems are indeed effective."
This discussion has been archived. No new comments can be posted.

Study Says E-prescription Systems Would Save At Least 50k Lives a Year

Comments Filter:
  • 10 years ago... (Score:5, Interesting)

    by goathumper (1284632) on Monday February 20, 2012 @10:04AM (#39098897)

    I worked on a hospital system 11 years ago that would provide this sort of cross-referencing functionality. It always baffled me why their use wasn't widespread. Back then there were (evidently) no smartphones, etc, so the whole idea of having barcodes on patients' wrists was revolutionary, as was the concept of having computer systems perform the drug-to-pathology matching and medication interactions analyses.

    From what I learned working on that project, this sort of system can lower the costs of operation, staffing, and evidently lower risk inside a hospital. Does anyone out there know why they've not seen widespread adoption (besides the "obvious" tin-foil hat doctor-nurse-conspiracy theories)?

    • Re: (Score:2, Informative)

      by SteelKidney (1964470)
      I expect that reading the Daily WTF ought to answer your question. Or Diebold's attempts to use whatever legal maneuvers they could in order to cover up the fact that they were selling extremely poor-quality software. Or the fact that Sony got so thoroughly and completely pwned over the past couple of years that it's not unreasonable to assume that anything more complicated than "Hello World" written by a Sony team is yet another hack waiting to happen.
    • I worked on a hospital system 11 years ago that would provide this sort of cross-referencing functionality. It always baffled me why their use wasn't widespread.

      Because non-tech people usually don't understand the "computer is a universal tool" thing and have problems stretching the limits of their imagination ("I had no idea a computer could do that for me...")

      • Because non-tech people usually don't understand the "computer is a universal tool" thing and have problems stretching the limits of their imagination ("I had no idea a computer could do that for me...")

        Because IT evangelists think that every problem in the world can be reduced to computer code, and they create medical systems without understanding how medical practice works.

        Then the doctors try the system out, it runs into problems ("It takes me longer to enter a prescription into this computer than it does to write it on a prescription blank by hand"), and they correctly go back to the older manual systems that work better.

        Doctors aren't stupid. They use lots of new technology every day. When something w

        • I've worked on systems that were ancient, by any stretch of the imagination ; VB3 extensions of prescription labelling systems originally written in BBC BASIC. 17 years old at the time, and this was 10 years ago.

          This thing would detect a large number of common drug interactions. Just the savings on transcribing prescription charts were worth it though.

          The handwritten paper charts we used would last two weeks. Many of our patients were on multiple medications. Legally speaking, the only person who's permitte

    • The problem is, there are only 2 groups that seem to provide these databases.. Neither are cheap. I am sure there is a LARGE amount of liability for developing such a database..

    • The interesting thing is that the whole system had been proposed and led by doctors. They knew the benefits and seemed to actively want them. Perhaps most crucially: the system didn't take doctors out of the loop - humans could still override the computer's warnings/indications/whatnot as necessary (obviously this would be well-audited).

      I agree that the risk of replacing humans with technology is still there. And yes - hacks are always possible as long as humans are in the mix of creating the computerize

    • Re:10 years ago... (Score:5, Insightful)

      by demonlapin (527802) on Monday February 20, 2012 @01:01PM (#39100529) Homepage Journal
      I'm a physician whose hospital just tried to push all orders onto electronic order entry - not just medications but diet orders, PT/OT/nursing orders, everything. It got massive pushback. Why?

      Most doctors see patients at more than one hospital. Many use an electronic system at their clinic. They have to remember five or six usernames, passwords, and different ways of doing things, any one of which is likely to change at any time due to an upgrade, and some of which they may not use for months (as an example, many surgeons maintain privileges at a wide variety of hospitals to be able to suit patients - but they may not operate at a given one for two or three months at a time). The interface is often clunky. And they're SLOW. Paper is FAST.

      Great example from a committee meeting last week: one endocrinologist is part of a group that has taken over management of difficult diabetic inpatients. Most of them have Medicare, or Medicaid, or nothing at all. From his perspective, he's getting paid very little for his work. On paper, he can check blood sugars, write an order, and move on to the next patient in about two minutes. On computer, the same process takes about five minutes. Thirty patients an hour versus twelve... and so he said that if he's forced to do electronic, he will just stop doing the difficult diabetic management. It's no longer worth his time.

      And, as others have said, these systems are fantastically expensive, and so while there are some savings to be reaped they are mostly taken by the vendor and the increased IT expenses. And then your vendor decides to EOL your software... what do you do then? Buy their replacement product, because it's a lot cheaper to stay with the same vendor? Buy a new whole-hospital system from another vendor? We're wrestling with that now.
    • by nbauman (624611)

      I used to evaluate medical office-based systems about 15 years ago, and I kept an eye on the field ever since.

      They made wonderful predictions, about half of which came true. (I made predictions. Mea culpa.)

      The billing systems worked very well. When they went to Medicare/Medicaid billing, the investment paid for itself in about 6 months.

      The clinical systems didn't always work so well.

      Transmitting lab reports worked very well. They substituted a standard paper format for a standard electronic format.

      Keeping p

    • by Darinbob (1142669)

      Well, for some reason new medical technologies take a long time to get accepted. It's a tough market to sell in. Doctors and hospitals are not like teenagers willing to through away last month's phone for the newest model. They do adapt but they will never adapt at the rates the kids or slashdotters will or experiment so readily.

      Let's say it takes 10 years to really get a good foothold. But in those ten years the nature of devices has become radically different. These companies started out on Palm Pilo

  • NHS e-Prescribing (Score:2, Insightful)

    by Anonymous Coward

    Here in the UK, system like this are in use in both General Practice and in Hospitals. I worked for a company for seven years that supplied software that did precisely this to NHS and private hospitals both here an abroad. I wonder how the stats compare between the UK and the USA in this regard?

    • by ledow (319597)

      Whether it exists doesn't correlate to whether it's used.

      My girlfriend had an argument with her doctor only the other week because he hand-filled out the prescription, gave it to his medical receptionist, who took it upon herself to post it to the local Tesco's (whose pharmacy staff really are a waste of space) without ever asking.

      The Tesco's couldn't fulfil it so she had to fight to get the paper prescription back, take it to Boots herself (who could only fulfil half of it, and did so without asking first,

    • by nbauman (624611)

      People tell me that I romanticize the UK health care system too much (probably from reading BMJ and Lancet in my younger days), but my understanding was that the NHS gives a lot more emphasis to systematic evaluations than we do in US.

      I thought that when they rolled out their health care software, they did a lot of careful testing and evaluation, compared to what we did in the US. True?

  • Stick an e- in front of it. Magic!

    • by gmack (197796) <gmack@in n e rfire.net> on Monday February 20, 2012 @10:29AM (#39099095) Homepage Journal

      If the doctor could log in and select the medication and have the pharmacy read the prescription it would, on it's own, prevent a lot of errors that happen from misreading prescriptions. On top of that, if there is something wrong that requires a specialist then the patient is in a fun place where no one doctor knows what all medications are prescribed so a system that did any sort of automated conflict checking could save a lot of lives.

      The current system is far from perfect, I once almost lost my job because some pharmacist misread my prescription for Singulair (Asthma med) and gave me an antipsychotic instead and for a week I couldn't be motivated to do anything.

      • If the doctor could log in and select the medication and have the pharmacy read the prescription it would, on it's own, prevent a lot of errors that happen from misreading prescriptions. On top of that, if there is something wrong that requires a specialist then the patient is in a fun place where no one doctor knows what all medications are prescribed so a system that did any sort of automated conflict checking could save a lot of lives.

        The current system is far from perfect, I once almost lost my job because some pharmacist misread my prescription for Singulair (Asthma med) and gave me an antipsychotic instead and for a week I couldn't be motivated to do anything.

        A better solution would be that if the pharmacy cannot read the prescription, then they don't fill it. It should be the doctor who has the responsibility to make sure that what he/she is ordering is clear and understandable, not their receptionist or some clerk at the pharmacy. Doctors should be held accountable for prescription mistakes that are caused by their own haphazard penmanship.

        • A better solution would be that if the pharmacy cannot read the prescription, then they don't fill it. It should be the doctor who has the responsibility to make sure that what he/she is ordering is clear and understandable, not their receptionist or some clerk at the pharmacy. Doctors should be held accountable for prescription mistakes that are caused by their own haphazard penmanship.

          Exactly that. The pharmacist needs to be talked to in a manner that will get their attention. If you don't understand something, get it checked out.

          This, however, is the main reason for an e-prescribing system - not the interactions (the database sucks, way too many false positives). But there are literally thousands of drugs out there and names can be annoyingly similar. Decimal place errors can be a big problem as well. You need the information presented in a clear UNAMBIGUOUS fashion. Only way to d

        • Or an even better solution, check the name of the drug prescribed to you with the label on the container before taking it! My doctor has ALWAYS said, "I'm prescribing this for you, take X amount per day." I check the note he gives me and I check the bottle when I pick it up. I even check to make sure the pills inside match the description given in the documentation. If people are involved, mistakes WILL be made. The pharmacist reading it off the computer can misread it, accidentally grab the wrong bottle, p

      • If the doctor could log in and select the medication and have the pharmacy read the prescription it would, on it's own, prevent a lot of errors that happen from misreading prescriptions.

        And in keeping with tradition; the doctors would write them in COBOL while the pharmacy writes in BASIC.

    • Stick an e- in front of it. Magic!

      That's so Twentieth Century. Now you have to stick an i- in front of it to make it cool.

  • by fph il quozientatore (971015) on Monday February 20, 2012 @10:17AM (#39099005) Homepage
    How dare you replace a competent, well-trained, warm-hearted human with an emotionless machine?
  • by Troyusrex (2446430) on Monday February 20, 2012 @10:24AM (#39099065)
    by implying that drug errors are causing 50,000 to 100,00 deaths a year when, in fact, drug issues are a very small portion preventable adverse events (PAE). Things like falls and catheter infections are far more common. The article mentions that drug allergies and cross drug reactions are already extremely low and unaffected by implementing e-prescription (probably because the computers in the pharmacy already alert to this). The only thing effected are illegible prescriptions. I think e-prescriptions are a fine idea but this article is misleading as to how much benefit it would have in terms of lives saved.
    • by dstates (629350)
      Agree. The IOM study cited in the article is more than a decade out of date and there are many causes of preventable adverse events. In some respects, electronic order entry systems actually confound the allergy and adverse reaction problem because comments about allergies accumulate and are never reviewed. An elderly patient may have mentioned a decade ago that they were "allergic" to some medication because they got a headache after they took it, but once that allergy is on the drug allergy list, no on
      • by vlm (69642)

        An elderly patient may have mentioned a decade ago that they were "allergic" to some medication because they got a headache after they took it, but once that allergy is on the drug allergy list, no one is going to put themselves on the line and delete it. As a result, the lists of drug allergies tend to accumulate junk over time and may prevent physicians from using the most appropriate medication.

        Amoxocillian makes me puke, at least it did once 30 years ago. Or maybe I puked after amoxocillian because I was home from school and ate nothing but junk food because I was sick and miserable. Fast forward 30 years and horrible ear infection from my ear infected kids, go to doc, amox worked great on the kids but I can't have it. Doc suggests something and warned me of horrific side effects (was it cipro ?). I talked him off the ledge and we agreed zithromycin would be safer and more appropriate. 4 hou

        • The most common mis diagnosis in American medicine is 'Penicillin Allergy' (which would generally include amoxicillin). For exactly the reasons you cite. Actually, most EMRs do have some ability to at least explain the interaction. If I saw "Amoxicillin Allergy - nausea" on your chart, I would ask the circumstances and quite likely might prescribe it, especially if you were willing to 'experiment'.

          There is a test for true penicillin allergy that's reasonably safe but requires some expertise so is usually

      • by Rich0 (548339)

        Agreed. A big problem is that often there is only a binary allergic/not-allergic list.

        My wife has been to the hospital numerous times and I end up going through the allergy list when she is unable to do so. Half the stuff on the list raises eyebrows because they are medications that she regularly takes. I explain to them that she isn't allergic to them, but that she does have sensitivities that should be considered (lower does, extended-release, avoid if possible, etc). They end up leaving them on the a

        • The way to do that is to make the hospital financially responsible for the extra time. Then they have an incentive to fix it (despite the loud announcements by various Mission Statements, quality medical care isn't something most hospitals will take a whole lot of time with).

          Medicare is trying to do this, but as usual they bring a sledgehammer to a knife fight. Dangerous to all involved but unlikely to do what you set out to do without wrecking the rest of the house.

    • I saw an article a few years ago that gave a great comparison. Sorry I can't find the reference, but at the time it said your chance in a hospital of getting the wrong medication ("wrong" defined as not what you were prescribed; never mind unnoticed conflicts and so on) was higher than the chance on a commercial flight of having your luggage lost. Some of those are certainly from illegible prescriptions or poorly labelled units, but I bet more are from procedural mistakes.

      Still, electronic prescriptions s

    • by sammy baby (14909)

      Disclosure: I work for (but do not speak for in any official capacity) a company which provides electronic health software of the type discussed in this article.

      Even overlooking the use of pharmacy IT solutions, there is still a lot of room in clinical IT solutions generally to help combat PAEs. For example, software solutions can generate warnings to healthcare professionals when a patient is at a higher than usual risk for particular PAEs. For example, patients under heavy sedation or with loss of sensa

    • by Khashishi (775369)

      The main drug issue is when patients don't fill their prescriptions or they skimp on the dosage because they can't afford the drugs. If the e-prescription system leads to lower overhead and cheaper drugs, that is a good enough reason to implement it. If it's more expensive, then I don't believe the reduction in errors will turn out to be worth it.

  • This won't prevent all events, only those caused by pharmacists being unable to read hand-written prescriptions. There will still be those resulting from doctors misremembering the name of the medication or a pharmacist grabbing a wrong bottle. No doubt it would save a lot of lives, but most of those would be saved by simply typing prescriptions instead of hand writing them.

    Along the same line, however, there is a ridiculous amount of paper being faxed between doctors and between doctors and insurance comp

    • by Geraden (15689)

      Not true!

      While human error like you describe above certainly exists, these systems can also catch drug allergy interactions, drug-to-drug interactions, and even food-drug interactions. Along with the already-existing systems in most pharmacies, these systems provide another layer of protection for patients. They also provide doctors with real-time best-cost analyses, allowing them to prescribe the most effective, least expensive drugs based on a patient's particular drug coverage. This may help to lower

      • by Dcnjoe60 (682885)

        Robotic systems that are linked to the prescription and automatically fill prescriptions eliminate the pharmacy errors, .

        Assuming that the human who filled the bins that the robot uses to fill the prescriptions didn't make a mistake. There is always a human element involved and usually it is cost prohibitive to eliminate it entirely.

        • by Geraden (15689)

          So the same systems that verify if a potato chip is bad couldn't do a quick visual inspection of each pill, make sure it's the right shape, size, color, and has the correct markings?

          Seems like there are already industrial systems in place that can handle this - no need to do so much as reinvent the technology!

          • by Dcnjoe60 (682885)

            So the same systems that verify if a potato chip is bad couldn't do a quick visual inspection of each pill, make sure it's the right shape, size, color, and has the correct markings?

            Seems like there are already industrial systems in place that can handle this - no need to do so much as reinvent the technology!

            If I work at the chip plan and accidentally pour the sour cream and onion seasoning into the vat that the cheddar cheese seasoning was supposed to go into, that sensor on the chip line won't catch that, it is looking for shape and size and color variances (ie burnt). While it is true that there are already industrial systems in place that can handle things like this, who would you suggest foot the bill for installing them in every pharmacy, hospital and clinic in the country?

            Even if they are installed, unl

  • Where isn't this in use? My GP can order a prescription from is computer in the room. Same goes for any hospital, etc I've been in. The only thing that requires the actual script is scheduled drugs because it's (theoretically) harder to forge.

  • by Ronin441 (89631) on Monday February 20, 2012 @10:31AM (#39099113) Homepage

    The summary (mostly) included one of the two key facts:

    each year approximately 50,000–100,000 people die in America because of [...] medical errors

    But not the other:

    implementation of e-prescription systems resulted in an approximately 60 percent reduction in total medication-error rates, and a 44 percent decrease in serious medical errors

    So the expected improvement is 22k to 44k less deaths per year in America.

    • The summary (mostly) included one of the two key facts:

      each year approximately 50,000–100,000 people die in America because of [...] medical errors

      But not the other:

      implementation of e-prescription systems resulted in an approximately 60 percent reduction in total medication-error rates, and a 44 percent decrease in serious medical errors

      So the expected improvement is 22k to 44k less deaths per year in America.

      If the summary is correct (not a given!), there are 50,000-100,000 total PAEs. But only a fraction are going to be prescription-related, so the number of lives saved is probably much lower.

      • by Dcnjoe60 (682885)

        If the summary is correct (not a given!), there are 50,000-100,000 total PAEs. But only a fraction are going to be prescription-related, so the number of lives saved is probably much lower.

        Exactly right. While the discussion seems to be focused on the wrong medication being dispensed or even drug interaction, it is far more common that the correct medication, but at the wrong dosage is dispensed. Dosage errors are not going to be picked up by an e- system.

    • Just because they made an error, that doesn't mean a death resulted from the error. A patient's blood pressure may have shot up or down for a day, but (unacceptable though it is) they might have caught it and it might not have harmed him.

  • Disclaimer: I work in the field, but am NOT associated with any particular vendor.

    Even more effective than stand-alone eRx systems are Electronic Medical Record systems with integrated eprescribing. The ability to better track & manage patients' problems longitudinally provides for much better care and better outcomes.

    I recognize that there are, however, some fairly major privacy concerns....many of which still exist at the ePrescribing level. Let's face it, if a system knows what you're taking, it do

    • I recognize that there are, however, some fairly major privacy concerns....many of which still exist at the ePrescribing level. Let's face it, if a system knows what you're taking, it doesn't take huge logical leaps to deduce your underlying conditions.

      Hey, maybe I take that Viagra for my acne!

    • it doesn't take huge logical leaps to deduce your underlying conditions.

      If we had a sane healthcare system in this country, nobody would care what conditions you might have.

      As it happens, in the current US system healthcare coverage is inexplicably all entangled together with your employment. So your boss, (the one party that you would probably be least happy knowing about your health status) not only knows all about it, but is also in a position to cut you off from both your income and your healthcare coverage.

      • Clearly you are a pinko. Embittered smart-assery aside, I know several people, and I'm one of them, who have delayed treatment or consultation with a doctor for fear of acquiring a "pre-existing condition." In my case, I have had symptoms of prostate cancer for several years, but I kept putting off diagnosis because I was on the job market and feared losing coverage of any treatment I might need. Now that I have a decent job, and that I've been tested and received a negative diagnosis, I look back and think
  • Article title assumes e-Prescription systems will solve most problems of the current system.

    If rolled out into wide deployment, e-Prescription systems will have a lower success rate than they currently do in the hands of people who want them.

    If abused with contempt, e-Prescription will perform worse than current systems, though if implemented with fidelity, the e-system could at least point a finger at the weak link in the chain, if anyone cares enough to analyze the records and develop witch hunt reports.

  • by orphiuchus (1146483) on Monday February 20, 2012 @10:35AM (#39099143)

    I got some shit advice from the medical staff at my university. I'm taking a drug called celexa and got a cold, not wanting any adverse interactions I called them up and asked what medicine it was OK for me to take. Coricidin Cold and Cough they said, was the safe choice.

    I Googled it before I went to the store and found a major interaction via drugs.com. A potentially fatal interaction. Super.

    • by geogob (569250)

      That's exactly the kind of mistake that leads to such high mortality figures. I couldn't believe it as i read the summary and on. I never would have thought PAE related mortality would be so high in the US.

      But even the best system can't compensate for human incompetence and laziness. In your case, you either got someone on the line who had no clue and too lazy to either refer you to someone who had one or check it up or to someone really incompetent. Even the best electronic tracking system wouldn't have he

      • Anyone, we often tend to forget that doctors are not experts in medication. The only know so much. Pharmacist and pharmacologist are the reference in this field... they are the one we should ask question regarding medical interaction.

        I don't take a bunch of medicines, but my experience has been pretty consistent that doctors don't spend a lot of time talking about medication or dose, but pharmacists are very reluctant to question prescription-related decisions by doctors (eg, this medicine vs. another, dosa

        • by geogob (569250)

          The pharmacist and the doctor are not competitors in the world of the best advice. They are two professional, each having their field of expertise. They have to work together to give the best possible treatment to the patient.

          If either sees questioning of some advice as negative, then there is a fundamental problem - and this is where reform needs to start. Of course, working together does imply taking the time to talk to each other when problem arise.

          I lived most of my life in Canada, and if my pharmacist

    • by vlm (69642)

      Coricidin Cold and Cough they said, was the safe choice.

      The new stuff made from chlorpheniramine or the old stuff made from psudephedrine?

      Thats the "killer" with brand names.

      • The problem with Celexa + Coricidin would be the dextromethorpan (the 'cough' part) which can trigger serotonin syndrome. This points out the problem with these databases. There is very little practical information. The dextromethorpan-Celexa interaction is a generic one between the SSRI class of antidepressants (Celexa, Prozac, Zoloft, etc - the common ones) and the dextromethorpan. From what I've been able to look up briefly it would take a significant dose of both drugs to trigger the effect which c

  • We have this e-prescription system in Estonia for over 2 years now, nation wide. The good - It's easier to get some recurring prescriptions that you have to take all the time, you just calle the doctor and say you are running low on the meds, he checks your previous prescriptions and can easily see that yes, you should have only a few left... (to detect you are not attempting to scam extra medicines for black market or something). Also another good thing is that combined with an electronic pharmacy databas
  • And I hate them both! I have tried to make use of the CVS pharmacy automated refill system, but from what I can tell the "automation" goes into a blackhole and requires manual intervention. The system the doctor pushes is to fill out a form on their website, but from what I can tell it just generates a phone call from them to the pharmacy... sometimes. For me it is a major hassle, especially since my drugs are not considered "maintenance" prescriptions and have limits on getting insurance to cover mutli-month supplies. - HEX
  • by Anonymous Coward

    Not every medical error that causes death is a prescription error, so helpful as this system may be, it probably won't save quite as many lives as advertised.

  • Since our society currently does not allow assisted suicide, please leave a loophole so doctors can prescribe fatal overdoses of morphine or other painless life cures. Terminal patients, people in vegetative states and miserable suicide-prone Goths everywhere will thank you.

    It is interesting to me how almost Goedelian any set of rules can be. We always need to leave exceptions, or we strap ourselves into a Catch-22 (mixed with Brave New World) maze of rules that eliminate the finer points of decision making

    • by Skidborg (1585365)
      So how does the system tell the difference between an intentional assisted suicide, an accidental overdose, and a premeditated murder?
  • My wife works in Assisted Living. She's had many situations where residents have shown signs of mental or physical degradation because of medication interactions. Not because one doctor prescribed interacting drugs, but because separate doctors prescribed interacting medications. The multi-specialist medical industry assumes that the patient is a medical expert, and can keep track of their medications AND know the interactions. All responsibility is in the hands of the patient. And guess what ? Most of us d

  • I'm not sure, but that claim that this is the leading cause of death in America seems a bit, uhm, off. I suspect there are some broad qualifications to that statement, like leading cause of preventable deaths?..

    Interesting it didn't make this CDC list of causes of death: http://www.cdc.gov/nchs/fastats/lcod.htm [cdc.gov]

    From the report:

    Heart disease: 599,413
    Cancer: 567,628
    Chronic lower respiratory diseases: 137,353
    Stroke (cerebrovascular diseases): 128,842
    Accidents (unintentional injuries): 118,021
    Alzheimer's disease

  • Slashdot addiction.
  • I was talking to my cousin who is a doctor. They have this new fangled iPad based prescription system. Its user interface has been designed by programmers for programmers. As usual they had this wonderful idea to offer edit boxes with drop down auto completion options. (Yeah, it is going towards "got the right Bob?" gmail extension). She completed a prescription, had a nagging suspicion that the down click did not register and the first prepopulated suggestion has been posted. But the form has vanished, no

"Regardless of the legal speed limit, your Buick must be operated at speeds faster than 85 MPH (140kph)." -- 1987 Buick Grand National owners manual.

Working...