Strategies Toward Simpler, Safer CPOEs
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On its face, computerized provider order entry is a no-brainer. Make it easier for physicians to order clinical tests, labs, and medications. Alert them to allergies and possible drug interactions. Eliminate paper and the errors caused by poor handwriting and transcription errors. Avoid duplicate tests and procedures. Improve communication and coordination among caregivers. It all adds up to safer, simpler, more effective, and less expensive healthcare.
If only it were so easy.
Simply having a system in place isn't nearly enough. Incomplete or inaccurate order sets, hurdles to adoption, and lack of testing can turn a system that's supposed to improve patient safety into one that can put patients at risk.
Consider a recent study by the Leapfrog Group, the Washington, DC-based nonprofit that helps initiate improvements in the safety, quality, and affordability of healthcare. Using a Web-based simulator, 214 hospitals tested their systems to see if they would catch common medication errors, including potentially fatal errors. The CPOE systems on average missed half of the routine medication orders and a third of the potentially fatal orders. Leapfrog also looked at a subset of 102 hospitals that had taken the test twice between June 2008 and January 2010 and found that nearly every hospital improved in one or more medication categories.
This should be a red flag for every hospital and IT company in America, says Leapfrog CEO Leah Binder. "The belief that simply buying and installing health information technology will automatically lead to safer and better care is a myth."
One solution, according to the Leapfrog Group: Healthcare organizations must put aside competition and do a better job of working together to share best practices in CPOE adoption.
Only about 10% of the 1,244 hospitals that responded to the Leapfrog Group's annual survey in 2009 are meeting the group's overall CPOE standards, which includes entering 75% of medication orders through the CPOE system and passing the CPOE evaluation. To pass, a hospital's CPOE system must catch at least 50% of medication errors during the simulation. That's a low number, Binder admits, but the standards will be raised toward the ultimate goal of averting 100% of potential errors. The number of organizations currently meeting the overall standards is small, Binder says. But those that haven't yet caught up can learn a lot from those that have achieved the goal. "You're no longer a pioneer in the woods trying to do it alone."
Three large health systems have done just that, forming a Care Collaborative to create a library of more than 1,000 order sets. St. Louis?based Ascension Health, the Winter Park, FL?based Adventist Health System, and San Francisco?based Catholic Healthcare West developed the sets in partnership with clinicians. They are working with Zynx Health, a decision-support vendor based in Los Angeles, which will offer the sets to other healthcare organizations via subscription.
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