Dr. David Bates helped develop CPOE

Dr. David Bates helped develop a computerized physician order entry (CPOE) system to reduce medical errors.

Reducing medical errors relies on the conscientiousness, diligence, and teamwork of health care professionals. But recent research shows that adding technology to the team helps to make health care even safer – much safer.

One such piece of technology is the computerized physician order entry system (CPOE), which enables physicians, physicians’ assistants, and nurse practitioners to enter medication (or test) orders into a computer instead of using a handwritten form. These computerized orders are easy to read, and, more importantly, the system software can also deliver tips, reminders, best practices, and automatic alerts about potentially harmful drug interactions or allergies.

Brigham and Women’s Hospital (BWH) pioneered the development of a CPOE system in 2004, building it from the ground up and helping establish a model for what is now a nationally accepted safety practice. Since that time, BWH research has demonstrated that implementing CPOE can have a tremendous impact on reducing medication errors in hospital settings.

However, most hospitals don’t have the IT capacity to build such a system on their own, so vendor-developed systems have become the norm. And since almost all studies of CPOE impact have been done on internally developed systems, it hasn’t been clear whether results with vendor systems would be similar.

To address this issue, BWH researchers recently examined the impact of incorporating vendor-developed CPOEs at five community hospitals in Massachusetts. For the five-year period following the implementation of CPOE systems at these hospitals, there was a 34 percent reduction in preventable adverse drug events (ADEs), but the rate of near-misses (errors that had potential to cause harm but didn’t cause harm) actually went up. This shows that vendor-developed CPOE systems were preventing the most important errors, but also revealed that many hospitals were allowing orders to go through without checking them for errors – supporting the notion that the success of these systems relies on human vigilance.

“We knew from prior research that there was potential to significantly reduce preventable ADEs at community hospitals through CPOE, but we hadn’t examined the effectiveness of vendor-developed systems,” says Dr. David Bates, Senior Vice President for Quality and Safety at Brigham and Women’s Hospital and senior author on the study. “This most recent research demonstrated that vendor systems could indeed deliver benefit, but also showed that they could be implemented better.”

Numerous other studies have shown that CPOE helps. A 2004 U.S. study concluded that 64,500 lives could be saved and 907,600 serious medication errors could be prevented each year if CPOE was implemented in all urban U.S. hospitals. The landmark study of CPOE at BWH, also led by Bates, found that even a simple system reduced serious medication errors by 55 percent.

Yet, despite compelling evidence that CPOE and other technologies can significantly improve patient safety, only about 30 percent of hospitals nationwide and 40 percent of Massachusetts hospitals have established the use of CPOE and electronic health records (a sharable collection of electronic health information about individual patients or populations). But those numbers are bound to rise soon, as the U.S. government has provided financial incentives for U.S. hospitals to implement electronic health records and CPOE – thereby improving the likelihood that most U.S. patients will soon be benefitting from these very important technologies.

– Chris P

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