Study just out in JAMA finds CPOE facilitates 22 types of medication errors.

[docporter]

Check out the latest issue of JAMA. A study found that CPOE systems may reduce some types of errors, but they increase 22 (twenty-two) other types of errors, including "double-dosing," "incompatible orders" and "wrong orders."

[abower]

For computerization apparently the area of most trouble is data entry. That is according to one study where most errors occur.
Then there are those who deliberately want to illegally obtain information. That will become possible if all records become electronic and conversant with other systems. Take Choicepoint. For some the possible lack of privacy is very threatening.

[docporter]

Since HIPPA there is no privacy. Records may be exchanged with any "covered entity" if the purpose is to provide health care to a patient or to get paid for providing healthcare to a patient. There is no way to verify that the entity with whom you exchange information is actually protecting the privacy of any information.

[Kursk]

Cerner Responds to the JAMA CPOE Study: It’s Unsafe
to Implement Anything Less Than a Closed- Loop
Medication Process

After studying clinician usage of a vintage TDS CPOE system at the Hospital of University of Pennsylvania, researchers concluded “that a leading CPOE system often facilitated medication error risks, with many reported to occur frequently,” according to astudy published in the Journal of the American Medical Association (JAMA) on March 9.

The study on potential errors caused by CPOE, also reported, “As CPOE systems are implemented, clinicians and hospital must attend to errors that these systems cause in addition to errors that they prevent.”
Global media outlets paid significant attention to the study, with headlines such as:

“Computerized Prescription Systems Introduce New Errors” – NPR
“Hospital Computer Systems Failing to Deliver” – Forbes
“Doctors' Computerized Ordering Can Increase Medication Errors” - Baltimore Sun
Since the study was conducted, the Hospital of University of Pennsylvania replaced the TDS CPOE system.
Given the interest that this study has generated, it is important to understand the study’s deficiencies, the benefits of Cerner’s closedloop
medication process and the countless benefits that Cerner clients have achieved.

Study Deficiencies
1. The study is based on one hospital, the Hospital of University of Pennsylvania, and one implementation of an outdated CPOE
solution, Eclipsys’s TDS which is not currently marketed.
2. This is not a study about errors; it’s a study about potential errors. It does not measure actual errors or adverse events, nor does it compare paper ordering errors to computerized order entry.
3. The identified 22 potential errors contained “process” issues that should not be considered as errors.

Benefits of a Unified CPOE Solution that Enables Closed-Loop Medication Administration

1. Cerner’s approach to CPOE solidifies our position as an industry thought leader. Cerner CPOE addresses complex processes enabling unified medication management across physicians, pharmacists and nurses. Anything less than a closed-loop medication process is unsafe. The studied TDS ordering system was dis-coordinated across physician, pharmacist and nurse processes.
2. Cerner’s contemporary user interface supports clinician workflow.
The studied TDS ordering system was pre-windows, difficult to read, and required multiple screen “flips” to get vital information (up-to 20 pages for a patient’s medication).
3. Cerner works with our clients (in the ASC, the Design Center and through Cerner Consulting) to continuously design and embed effective role-based processes. The studied TDS system had extensive process problems exacerbated by extensive downtime.

Cerner Client’s CPOE Experience
This morning, some Cerner client physicians completed an analysis of all 22 types of potential errors. The result: Cerner’s unified CPOE solution addresses all of potential errors highlighted in the study.
Real benefits are being achieved by our clients. Here are just a few examples:
• Children’s Hospital of Pittsburgh achieved a 50-percent decrease in medication errors that cause harm
• New York Methodist Hospital achieved a decrease of 8,120 patient days in 2004 by decreasing the ALOS
• Oklahoma Heart Hospital achieved 100-percent compliance with JCAHO core
measurements related to AMI, CHF and CAP

What the experts are saying about the study:

David Brailer, M.D., Ph.D National Coordination for Health
Information Technology
2004 Most Powerful Person in Healthcare

"The findings from this study show that the
particular way that computerized physician
order entry products are developed and
implemented makes all the difference in
whether quality is improved." (AHRQ press
release, March 9, 2005)

David Bates, MD. M.Sc.
Center of Excellence for Patient Safety Research and Practice
Serves on the Executive Committee of the
Dr. Bates criticized the Penn study because
it looked at an old computer system,
installed in 1997, and failed to examine
whether medication errors decreased
compared with the previous paper system.
Center of Information Technology
Leadership (CITL)
Dr. Bates said he worried that some
hospitals might use the study to delay
buying physician-order entry systems. (Wall
Street Journal, March 9, 2005)

Carolyn M. Clancy, M.D
Director of the Agency for Health Research
and Quality (AHRQ)
"While the findings are important, the
study focuses on the experience of one
hospital and one product and may not be
easily applied to industry at large," (AHRQ
press release, March 9, 2005)

Allen Vaida, PharmD, FASHP
Executive Director of the Institute for Safe
Medication Practices (ISMP)
Vaida thought the Penn study left the
wrong impression because it evaluated a
system that had been surpassed by more
sophisticated models.
"We just hope people won't look at the
study and say, `See, I told you it doesn't
work.'" (Kansas City Star, March 9, 2005)
Source

Koppel, R., Metlay, J, Cohen, A., et al (2005, March 9). Role of computerized physician order entry systems in facilitating medication errors. Journal of American MedicalAssociation. Retrieved March 8, 2005 from http://jama.amaassn.org/cgi/content/full/293/10/1197

Disclaimer: I do not work for Cerner. Do not imply that I am suggesting you buy Cerner software based on this manifesto. I provide this as a counterpoint to the JAMA article and to stimulate discussion.

K