On June 30, leaders of the Washington, D.C.-based Leapfrog Group, the large healthcare-purchaser organization focused on patient safety and value, held a telephone press conference to highlight the results of their new study on computerized physician order entry (CPOE). The report, titled “Leapfrog Group Report on CPOE Evaluation Tool Results, June 2008 to January 2010,” discusses the process whereby leaders at 214 U.S. hospitals performance-tested their CPOE systems for their ability to detect common medication and other errors, using Leapfrog's Web-based simulation tool.
Aggregating the results from that testing process, Leapfrog leaders announced that, collectively, 52 percent of the adult medication orders tested, and 42.1 percent of the pediatric medication orders tested, did not trigger appropriate warnings or alerts within the CPOE systems. What's more, of the potentially fatal adult orders involved, 32.8 percent of adult and 33.9 percent of pediatric order sets did not spur appropriate warnings to clinicians. Among the numerous issues evaluated included single and cumulative dose limits, contraindicated route of administration and age- or weight-based dose limits, and therapeutic duplication.
The obvious lesson, said Leah Binder, Leapfrog's CEO, is that, in addition to moving forward to participate in the stimulus funding expected to be released to hospitals and physicians under the federal American Reinvestment and Recovery Act/Health Information Technology for Economic and Clinical Health (ARRA-HITECH) Act, every hospital implementing a CPOE system needs to test and retest its system's performance, in order to ensure that it is actually averting medication and other orders. “CPOE systems are not plug-and-play,” Binder emphasized during the telephone press conference. “And that's true of any technology implementation in any industry. There's a complexity to the adoption process that has to be honored, and then systems have to be tested and monitored regularly over time. But CIOs are somewhat at a disadvantage now, because there's so little information available to them to do this complex implementation process,” she added. “Every CIO shouldn't have to reinvent the wheel each time,” she said. “They shouldn't have to rely only on their vendors for information.”
In other words, she urged, it was time for the leaders of the large majority of hospitals that have not yet fully implemented CPOE, to turn to the pioneers, for conceptual and practical help in moving forward. (Only 12 percent of U.S. hospitals have fully implemented CPOE, according to the Leapfrog's standards and validation process.)
“The good news,” said Dr. Barbara Rudolph, Leapfrog's senior science director, “is that 102 hospitals have taken the test twice-we require at least a six-month interval between tests. And those hospitals clearly worked on their systems between tests, because 94 percent improved their systems' performance during that interval. And that tells us that this test is useful. And we are glad that this tool can help them do so. But ultimately, the findings are disturbing.”
Binder, Rudolph, and their colleagues noted that Leapfrog is actively working with the Chicago-based Healthcare Information and Management Systems Society (HIMSS) to, as Binder said, “develop a Wiki that will offer hospitals the opportunity to share information about the adoption of CPOE; they're close to being live with this Wiki. Hospitals will be able to continually update their colleagues,” once the Wiki goes live sometime this summer.
In addition to supporting federal funding for CPOE implementation in hospitals, and to working with HIMSS to provide knowledge-based tools for CPOE implementation, performance testing, and optimization, David Knowlton, president and CEO of the New Jersey Health Care Quality Institute, and chair of the Leapfrog board of directors, said that “Leapfrog will continue to push for hospitals to adopt CPOE. CPOE systems can reduce adverse drug events by up to 88 percent, preventing 3 million adverse drug events a year in the U.S., and saving billions of dollars. It will not be sufficient to rely on the memory and skills of individual clinicians” going forward, he emphasized.
For more information on this initiative and to see a PDF copy of the report, go to http://www.leapfroggroup.org.
Healthcare Informatics 2010 August;27(8):27