Last week, yet another alarming Computerized Physician Order Entry
(CPOE) study made headlines. According to Healthcare IT News, The Leapfrog Group, a
staunch advocate of CPOE, is now “sounding
the alarm on untested CPOE” as their new study “points
to jeopardy to patients when using health IT”. Up until now we had
inconclusive studies pointing to increased and also decreased mortality
in one hospital or another following CPOE implementation, but never an
alarm from a non-profit group who made it its business to improve
quality in hospitals by encouraging CPOE adoption, and this time the
study involved 214 hospitals using a special CPOE evaluation tool over a
period of a year and a half.
According to the brief Leapfrog
report, 52% of medication errors and 32.8% of potentially fatal
errors in adult hospitals did not receive appropriate warnings (42.1%
and 33.9% accordingly, for pediatrics). A similar study published in the
April edition of Health
Affairs (subscription required), using the same Leapfrog CPOE
evaluation tool, but only 62 hospitals, provides some more insights into
the results. The hospitals in this study are using 7 commercial vendors
and one home grown system (not identified), and most interestingly, the
CPOE vendor had very little to do with the system’s ability to provide
appropriate warnings. For basic adverse events, such as drug-to-drug or
drug-to-allergy, an average of 61% of events across all systems
generated appropriate warnings. For more complex events, such as
drug-to-diagnosis or dosing, appropriate alerts were generated less that
25% of the time. The results varied significantly amongst hospitals,
including hospitals using the same product. To understand the
implications of these studies we must first understand the Leapfrog CPOE evaluation tool,
or “flight simulator” as it is sometimes referred to.
