Computerised Physician Order Entry (CPOE) - Many Getting it Wrong?

The following rather alarming report appeared a few days ago.

Get CPOE done right to prevent serious errors, Leapfrog warns

By Bernie Monegain, Editor

14/10/08

The Leapfrog Group warned Tuesday that incorrect deployment of CPOE systems could lead to serious medication errors.

"As CPOE systems are implemented at the clinical level in hospitals, we're seeing a broad variance in both the degree of adoption and in the quality of outcomes," Leapfrog CEO Leah Binder said.

Less than 10 percent of U.S. hospitals have fully implemented CPOE systems, according to Leapfrog.

Leapfrog recently developed its CPOE Evaluation Tool as a complement to its annual national hospital survey, which identifies the top performing hospitals across the country.

The Leapfrog Group is a consortium of major companies and large private and public healthcare purchasers. The organization's stated goal is to trigger giant leaps forward in the safety, quality and affordability of healthcare.

"There is no doubt that hospitals investing in CPOE are taking positive steps to address medication safety and a transition period between installation and effective implementation is natural and expected," Binder said.

The 2008 findings, she said, "indicate that collectively U.S. hospitals still have a way to go in addressing the technology, workflow and cultural challenges of CPOE implementation. We all need to recognize that installing a system is really just the beginning."

"The biggest value in Leapfrog's CPOE Evaluation Tool is that it gives hospitals the opportunity to gauge where they are with respect to clinical decision support in their CPOE implementation," said David W. Bates, MD, chief of general medicine at Brigham and Women's Hospital in Boston and a Leapfrog advisor. "While we saw considerable variability in how hospitals scored in 2008, the process of participating gave them a clear idea of what they now need to focus on in the absence of industry standards in decision support."

More here:

http://www.healthcareitnews.com/story.cms?id=10204

The full release can be found here:

http://www.leapfroggroup.org/media/file/LF_News_Release_CPOE_Evaluation_Tool.pdf

The fact that there is now an evaluation tool to assess the quality of CPOE implementations is a very good thing – but the requirements for quality implementation must be raised rapidly if the real life-saving benefits are to be captured.

There is no point is using a computerised ordering system that does not catch virtually all the errors that physicians and others are making. Baby improvement steps is not the way to go here.

It is vital that as NSW and Victoria implement CPOE in their hospitals that they use these audit tools to assess implementation quality. Additionally all GP e-prescribing systems should be audited to ensure they are meeting a very high error detection standards. (Maybe the National Prescribing Service could to this for the GP Community)

Pretty urgent action is required here I believe.

David.