Imagine this version of a word problem in math: You discover that, according to a 1999 report by the Institute of Medicine, between 44,000 and 98,000 Americans are being killed each year from medical errors. Apply to this number one solution: wide adoption of Computer Prescriber Order Entry (CPOE) systems. Now, calculate the reduction in deaths from medical error.
What’s the answer?
Well, the answer isn’t yet known. But what is known is that information technology is an integral part of building a safer health system. CPOE, says Dr. David Bates (Harvard Medical School and Brigham and Women’s Hospital, Boston, Massachusetts, USA), can have a dramatic impact on the rate of medical error, reducing serious errors by 55% and the overall medical error rate by more than 80%.
He offers this analogy: suppose a passenger on a commercial aircraft enters the cockpit for a tour and finds the instrument panel blank. Would you feel safe flying in such a plane? That’s what it’s like when a physician writes orders on a blank sheet — the way it’s still done in more than 90% of hospitals nationwide. CPOE, in contrast, brings together all kinds of patient-specific information, thereby ensuring better quality and increasing patient safety.
For example, CPOE systems are constantly performing checks in the background when doctors write orders. These checks include whether the patient is allergic to the drug, whether there are interactions with other drugs the patient is taking, whether the dosage ceiling for the drug is being exceeded, and so forth. When orders are entered that are contraindicated for the patient, alerts and reminders pop up. These give the prescriber options to change the order or provide additional data to substantiate the variance.
Bates says the first task in implementing CPOE (in addition to getting doctors comfortable with using computers) is to convince doctors that it is a better way to provide care. Physician involvement and leadership from the beginning of initiating CPOE are critical factors, as is strong support from hospital administration. Other stages of implementation include strategic planning and getting buy-in from all stakeholders, including nurses, ancillary personnel, and ward clerks — people who will also use the system.
Selecting a system is an expensive and long-term project. Clinicians must be involved, and installations must be personally visited. And these early stages are just the beginning: installation and integration of the system require a great deal of 24/7 technical support and training for users, as well as evaluation, adjustments, and improvements.
What’s the most important thing for a good CPOE application? It has to be fast. Fast, fast, fast.
Did we mention speed?
The recent and well-publicized suspension of a multi-million-dollar custom-designed CPOE system at Cedars-Sinai Hospital in Los Angeles, California, USA, is a cautionary tale. Because the system was deemed too slow and cumbersome, it ironically became a danger to patients, according to some doctors there. The system is now on hold.
But eventually the problems will be fixed. And, in combination with the conceptual support of the Leapfrog group, a number of pieces of legislation, and increasing physician acceptance of computerized work tools, sophisticated CPOE systems will become standard fare in the hospital of the not-so-distant future. In the long run, patients are the ones who really stand to win.
