Washington, D.C. -- Health information technology could inadvertently result in harm to patients without proper monitoring, according to a new report issued today by The Leapfrog Group, an employer-backed health advocacy organization.
The report calls on federal officials to act quickly by building oversight requirements into health care 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.
The report was made public June 28, 2010, during a press conference via telephone from Washington, D.C., where The Leapfrog Group is based.
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 one-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 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. Hospitals and vendors must continue to work together over time to ensure the effectiveness and efficiency of CPOE,” Binder noted.
The CPOE simulation is part of the annual Leapfrog Hospital Survey. According to Leapfrog, 26% of the 1244 hospitals that completed the survey in 2009 report having a CPOE system in at least one inpatient department. The Health Information & Management Systems Society notes that thousands more are in various stages of adopting or planning for these complex systems. Hospital critics have long criticized 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,” stated 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 to 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.
“And 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,” stated Keith Reissaus. Reissaus chairs a board committee formed to address the troubling 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,” Ms. Binder said.
The Leapfrog Group (www.leapfroggroup.org) uses the collective leverage of large purchasers of health care to initiate breakthrough improvements in the safety, quality, and affordability of health care for Americans. The Leapfrog Group was founded in November 2000 by the Business Roundtable and is now independently operated with support from its members.
The development of the CPOE Evaluation Tool and its accompanying order sets was funded under grants from the California Healthcare Foundation and the Agency for Healthcare Research and Quality. Order sets for pediatric and adult patients for the evaluation were developed, combining knowledge from published research with the experience and knowledge of the Institute for Safe Medication Practices and nationally recognized experts in the field of CPOE including Dr. David Bates (Partners Health care), Dr. David Classen (FCG, now CSC), Jane Metzger (FCG, now CSC), Dr. Marc Overhage (Regenstrief Institute), and Dr. Thomas Payne (University of Washington) among others.
Read the report here.