Quote Of The Year

Quote Of The Year - Paul Shetler - "Its not Your Health Record it's a Government Record Of Your Health Information"

Tuesday, May 04, 2010

Another Paper Showing How E-Health Can Make A Real Difference!

The following has just appeared in the US press.

Electronic medical orders may save lives

Frederik Joelving

Mon May 3, 2010 3:05pm EDT

NEW YORK (Reuters Health) - Doctors at a California children's hospital have found the first evidence that using an electronic system to communicate their orders may save lives.

After the system was introduced in 2007, the hospital witnessed a 20-percent drop in mortality rate, the equivalent of 36 fewer deaths over a year and a half.

"It's the lowest rate ever observed in a children's hospital," said Dr. Chris Longhurst, of Stanford University and Lucile Packard Children's Hospital in Palo Alto, California, whose findings are published in the journal Pediatrics. "It begs the question how many lives could be rescued on a national level."

In 1999, a report from the Institute of Medicine blamed medical errors for between 44,000 and 98,000 deaths per year in the United States. Many hospitals have since introduced so-called computerized physician order entry, or CPOE, in an effort to lower that number.

Such systems allow doctors to relay prescriptions to pharmacists without delay, and without the need for the pharmacist to decipher doctors' scrawl.

"What used to take 40 minutes or so now takes 20," Longhurst told Reuters Health.

Although close to three in ten U.S. hospitals use CPOE, no one had been able to show a decrease in mortality until now. In 2005, a Pittsburgh hospital even reported an increase in the number of child deaths after it implemented the system.

More here:

http://www.reuters.com/article/idUSTRE64216U20100503

There is also coverage here:

CPOE tied to lower mortality figures, study finds

By Maureen McKinney

Posted: May 3, 2010 - 12:01 am ET

Use of computerized physician order entry systems can correlate with significant drops in hospital mortality rates, according to results of a new study published in the journal Pediatrics.

In a joint collaboration, researchers from Lucille Packard Children's Hospital and Stanford University School of Medicine, both based in Palo Alto, Calif., reviewed nearly 100,000 patient discharges from the hospital from January 2001 through April 2009. In the 18 months following the hospitals' implementation of CPOE in 2007, there were two fewer deaths per 1,000 discharges, or a 20% decrease in mortality, according to the study.

The results come at a time when reports of CPOE's effects on quality and safety are varied, and some hospitals worry there may not be much of a return.

More here:

http://www.modernhealthcare.com/article/20100503/NEWS/305029987

The abstract to the original article is here:

http://pediatrics.aappublications.org/cgi/content/abstract/peds.2009-3271v1

Published online May 3, 2010
PEDIATRICS (doi:10.1542/peds.2009-3271

Articles

Decrease in Hospital-wide Mortality Rate After Implementation of a Commercially Sold Computerized Physician Order Entry System

Christopher A. Longhurst, MD, MSa,b, Layla Parast, MSc, Christy I. Sandborg, MDa,d, Eric Widen, MHAb, Jill Sullivan, RN, MSNd, Jin S. Hahn, MDe,f, Christopher G. Dawes, MBAd, Paul J. Sharek, MD, MPHf,g

Departments of aPediatrics,

eNeurology, and

fPediatrics, Stanford University School of Medicine, Palo Alto, California;

Departments of bClinical Informatics and

gQuality Management,

dLucile Packard Children's Hospital, Palo Alto, California; and

cDepartment of Biostatistics, Harvard University, Boston, Massachusetts

Background Implementations of computerized physician order entry (CPOE) systems have previously been associated with either an increase or no change in hospital-wide mortality rates of inpatients. Despite widespread enthusiasm for CPOE as a tool to help transform quality and patient safety, no published studies to date have associated CPOE implementation with significant reductions in hospital-wide mortality rates.

Objective The objective of this study was to determine the effect on the hospital-wide mortality rate after implementation of CPOE at an academic children's hospital.

Patients and Methods We performed a cohort study with historical controls at a 303-bed, freestanding, quaternary care academic children's hospital. All nonobstetric inpatients admitted between January 1, 2001, and April 30, 2009, were included. A total of 80063 patient discharges were evaluated before the intervention (before November 1, 2007), and 17432 patient discharges were evaluated after the intervention (on or after November 1, 2007). On November 4, 2007, the hospital implemented locally modified functionality within a commercially sold electronic medical record to support CPOE and electronic nursing documentation.

Results After CPOE implementation, the mean monthly adjusted mortality rate decreased by 20% (1.008–0.716 deaths per 100 discharges per month unadjusted [95% confidence interval: 0.8%–40%]; P = .03). With observed versus expected mortality-rate estimates, these data suggest that our CPOE implementation could have resulted in 36 fewer deaths over the 18-month post implementation time frame.

Conclusion Implementation of a locally modified, commercially sold CPOE system was associated with a statistically significant reduction in the hospital-wide mortality rate at a quaternary care academic children's hospital.

Key Words: safety • electronic records • mortality rates

Abbreviations: IOM = Institute of Medicine • EMR = electronic medical record • CPOE = computerized physician order entry • ADE = adverse drug event • LPCH = Lucile Packard Children's Hospital • CMS = Centers for Medicare and Medicaid Services • PHIS = Pediatric Health Information System • O:E = observed-to-expected • ARIMA = autoregressive integrated moving average • RRT = rapid-response team • CI = confidence interval

---- End Abstract.

Just another reason we have to seriously start on the e-Health journey sooner rather than later. To get to these capabilities is years off, but the old journey of a thousand miles story applies!

One really wishes our political leaders could see the faces of the children who are dying needlessly as they just dither around!

Applying sensible figures there are say 10 major children’s hospital facilities in our country so that works out at say 240 unnecessary deaths a year. What do these politicians think a child’s life is worth I wonder?

David.

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