WASHINGTON – To make sure patients are safe, hospitals have to put their CPOE systems to the test, warns healthcare industry watchdog The Leapfrog Group in a report released last month. Leapfrog, one of the strongest advocates in healthcare for the use of CPOE – computerized provider order entry, called on the federal government to make testing mandatory.
“Alongside the information about the results, said Leapfrog CEO Leah Binder, "we are also issuing a call to action for hospitals, technology vendors and the federal government because we do feel that the findngs are disturbing.”
The Leapfrog Group, an employer-backed health advocacy organization calls on federal officials to act quickly by building oversight requirements into healthcare IT regulations now being hammered out in Washington. The report also recommends actions that hospitals and CPOE technology companies should take to assure the quality and safety of these systems.
Using a Web-based simulation tool, 214 hospitals tested their computerized provider order entry (CPOE) systems for their ability to catch common medication errors, including errors that could lead to fatalities.
The CPOE systems on average missed half of the routine medication orders and a third of the potentially fatal orders. Nearly all of the hospitals improved their performance after adjusting their systems and protocols and running the simulation a second time. The simulations were conducted from June 2008 to January 2010.
"Although this is a simulation using fictitious patients and medication orders, it should be a red flag for every hospital and information technology company in America," said Binder. "The belief that simply buying and installing health information technology will automatically lead to safer and better care is a myth. Hospitals and vendors must continue to work together over time to ensure the effectiveness and efficiency of CPOE," she said.
The CPOE simulation is part of the annual Leapfrog Hospital Survey. According to Leapfrog, 26 percent of the 1,244 hospitals that completed the survey in 2009 report having a CPOE system in at least one inpatient department.
The Health Information and Management Systems Society (HIMSS) notes that thousands more hospitals are in various stages of adopting or planning for these complex systems. Hospital critics have long faulted the field for being too slow to adopt technology to improve care and save money. With about two-thirds of hospitals either losing money or existing on minimal margins, many say they need help to bring the technology to their communities.
"The federal government must exercise leadership here, because lives are at stake," said Leapfrog Chairman David Knowlton, president and CEO of the New Jersey Health Care Quality Institute. "As they define meaningful use as a standard for federal funding assistance to hospitals, they must require more than just adoption and implementation. The government must insist that hospitals and IT companies do continuous monitoring and improvement."
The CPOE evaluation tool used by the hospitals is the only one of its kind available today. The 214 hospitals that used it are voluntary participants in The Leapfrog Hospital Survey, a national patient safety survey that measures and publicly reports on how well patients fare, resources used to care for patients, and management practices that promote safety.
The hospitals that participate in The Leapfrog Hospital Survey are considered among the most advanced in the country in their use of information systems.
"It's time for the field to put collaboration ahead of competition and end the proprietary protection of best practices in adopting CPOE and other advances," said Keith Reissaus, who leads a Leapfrog committee formed to address the results of the CPOE test. He said the barriers to transparency should come down quickly in the interest of improving care for all patients and transforming the way hospitals operate.
"When CPOE is implemented the right way and hospitals and vendors follow up to monitor and improve it, the result is what every patient hopes for when their life is at stake: the perfect harmony of caregiver and technology working for them," Binder said.
Leapfrog offers its recommendations based on CPOE Evaluation Tool findings.
Alongside federal investment in technology, and as part of the definition of meaningful use, there must be a testing and monitoring component for all technology adoption in hospitals.
We must find a way to share information transparently about best practices for adoption of health information technology in hospitals. Competition is healthy, but in the case of IT adoption, collaboration is far better. Technology systems are not “plug and play.” They require thoughtful engagement by all stakeholders in the hospital system. Currently hospitals aiming to invest in CPOE or other HIT systems either rely on their vendor to map an adoption process or invent their own. This is not efficient and results in the performance variation that these studies found. Leapfrog is working with the respected Health Information and Management Systems Society (HIMMS) to formulate a set of best practices and disseminate them publicly.
Leapfrog and our purchaser members will continue to push for more hospitals to adopt CPOE. The evidence that CPOE saves lives and prevents the most common adverse event in hospitals – medication errors – remains abundant and urgent. CPOE systems can reduce adverse drug events by up to 88 percent, preventing three million serious medication errors in the U.S. each year, saving billions of dollars and alleviating significant human suffering. As medicine grows more complex, it will not be adequate to rely on the individual memories of each and every clinician to assure a plethora of medication errors are avoided. We will need to rely on advancing technology to support clinicians, and we will need to improve on the performance of that technology over time.
