WASHINGTON – “Disappointing” and “disturbing” are two words Leah Binder chose to describe the results of a recent survey that revealed only 7 percent of hospitals across the country have adopted CPOE.

CPOE, or computerized physician order entry, can reduce adverse events by 88 percent, according to Binder, the CEO of the healthcare watchdog organization The Leapfrog Group. And, she says, studies show that CPOE could avoid 3 million medical errors a year.

Other indicators that Leapfrog uses to measure the level of patient safety in hospitals also lagged behind the Leapfrog standards.

“It is disturbing, but it also gives us something to work with,” Binder said.

The 7 percent of hospitals that meet Leapfrog medication error prevention (CPOE) standards represents an improvement, Binder said. In 2002, only 2 percent of hospitals met the Leapfrog CPOE standards.

“CPOE is challenging and it takes time, said David Bates, MD, chief of the Division of General Internal Medicine at the Brigham and Women’s Hospital. He is also medical director of clinical and quality analysis, information systems at Partners HealthCare.

“It is costly – typically representing the most expensive capital item for a hospital over a five-year period,” he said. “Hospitals have generally not been paid more if they implement CPOE, and many are strapped for capital. The applications available to small and rural hospitals, which represent a large proportion of hospitals, are less robust than those for larger hospitals. The applications available today generally though are robust enough to deliver substantial benefit, and the main issue has been financial, although every installation requires some tailoring. We are still far from having this at a “plug and play” level.”

 Bates noted that the government’s stimulus package calls paying hospitals more if they implement CPOE. This is likely to result in a dramatic upswing in uptake by hospitals, he said.

 Computer physician order entry has been proposed to be an important component in reducing the incidence of adverse drug reactions and particularly those which might result in patient death, note Edgar D. Staren, MD, senior vice president for clinical affairs and chief medical officer, and Chad A. Eckes, CIO, Cancer Treatment Centers of America, in a recent blog posted on healthcareitnews.com.

 In fact, a number of reports have demonstrated a greater than 50 percent reduction in medication errors related to the use of CPOE, they say. “CPOE corresponds to a considerable functional evolution in EHR capabilities as it represents progression from clinicians passively reviewing electronically provided data to clinicians actively interacting with the electronic record,” they write.

The Leapfrog report also notes few hospitals are meeting Leapfrog’s newly established efficiency measure standards.

Among surveyed hospitals, efficiency standards – defined as highest quality and lowest resource use  – are met by only 24 percent of hospitals for heart bypass surgery, 21 percent for heart angioplasty, 14 percent for heart attack care and 14 percent for pneumonia care.

Other highlights of the 2008 hospital survey include:

    Also, low percentages of reporting hospitals are meeting volume and risk-adjusted mortality standards or adhering to nationally endorsed process measures for eight high-risk procedures, where following nationally endorsed and evidence-based guidelines is known to save lives:
          - 43 percent for heart bypass surgery;

          - 35 percent for heart angioplasty;

          - 32 percent for high-risk deliveries;

          - 23 percent for pancreatic resections;

          - 16 percent for bariatric surgery;

          - 15 percent for esophagectomy;

          - 7 percent for aortic valve replacement; and

-    5 percent for aortic abdominal aneurysm repair.

 * Sixty-five percent of participating hospitals do not have all recommended policies in place to prevent common hospital-acquired infections (HAIs).

* Seventy-five percent do not meet the standards for 13 evidence-based safety practices, ranging from hand washing to nursing staff competency.

* Only 26 percent and 34 percent of reporting hospitals are meeting standards for treating two common acute conditions, heart attacks (AMI) and pneumonia, respectively.

* Only 30 percent and 25 percent of hospitals are meeting standards to prevent hospital-acquired pressure ulcers or hospital-acquired injuries, respectively.

“In spite of huge opportunities for improvement, many hospitals are, in fact, demonstrating quality excellence and serving as role models,” said Binder. “We need to take the lessons learned from the best hospitals and use these to move the status quo forward so all Americans have access to safe, cost-effective care.”
Notable improvements by surveyed hospitals in 2008 include:

  * Thirty-one percent of hospitals now meet the Leapfrog ICU staffing standard, up from 10 percent in 2002.
  * Hospitals with all of Leapfrog’s recommended policies in place to prevent common HAIs jumped from 13 percent to 35 percent between 2007 and 2008.

  *  Sixty percent of hospitals have agreed to implement Leapfrog’s “Never Events” policy when a serious reportable event occurs in their facility.

“Progress on patient safety is moving too slowly,” said Binder. “Consumers and purchasers of healthcare want hospitals to implement safety standards and procedures known to improve quality and reduce unnecessary injury and death. The safety goals Leapfrog promotes are achievable. More hospitals should be meeting the Leapfrog standards for common and high risk procedures.”

The voluntary Leapfrog Hospital Survey results are as of Dec. 31, 2008, and include 1,276 hospitals in 37 major U.S. metropolitan areas, representing 48 percent of the urban, general acute-care hospitals (53 percent of hospital beds in these areas),