Hospital Turns to Computerized Systems to Cut Medical Errors
While a 1999 Institute of Medicine report prompted a "public clamor" over medical errors, some hospitals, such as Boston's Brigham and Women's Hospital, have tackled the problem with "computerized physician order entry" systems -- with "dramatic" results, the Washington Post reports. At Brigham, a computerized system "replaces paper," eliminating medical mistakes related to "illegible" handwriting, "unreadable" third-carbon copies and order sheets "stamped with the wrong patient's name." The system also "flashes a red signal" when doctors prescribe drugs that would prompt an allergic reaction in patients and informs doctors whether two drugs would interact or "duplicate" each other. For patients with kidney problems who need drug adjustments, the system "consults" the most recent lab data for the individual, calculates the "right dosage" of a drug that needs to be adjusted and "flags" test results that may "affect a drug's safety." The system also includes "stop-dates" in drug orders -- "making it impossible for a drug to be started and then forgotten" -- provides a "24-hour warning" before orders expire, and when doctors do not renew prescriptions, "a signal is sent to the locked medicine cabinet on the ward, preventing a nurse from dispensing the medication to the patient." While doctors can "override all prompts and warnings," they must provide an explanation, which a pharmacist reviews. Two years after Brigham implemented the system in 1993, the hospital's medication errors dropped 55%, with mistakes that harmed patients falling 17%. Additional improvements cut medication errors "86% from what they were a decade ago." Using the system, the hospital also saved $500,000 by "urging better use of an anti-nausea drug," canceled 69% of "redundant" lab tests, and "canceled or changed" one-third of "unnecessary" abdominal X-rays.
Still, less than 5% of U.S. hospitals have similar computerized systems, a "testament to how slowly this country has embraced systematic efforts to improve patient safety," the Post reports. "These things represent a dramatic and fundamental change to processes that have been in place for so long. They're also a huge investment in time and financial resources," James Keller, a researcher at ECRI, said, adding, "All that put together makes it tough to implement these systems." According to Keller, "[o]ff-the-shelf" versions of Brigham's system cost "a few million to tens of millions" of dollars. However, some experts argue that by 2010, computerized systems "may be like seat belts -- people will have a hard time imagining how anyone ever felt safe without them." The Leapfrog Group, a consortium of companies that provides health insurance for 20 million individuals, highlighted such systems as an "immediately achievable reform" that the group will "push health plans to adopt." In addition, malpractice lawsuits may "drive" hospitals to implement them. "Ultimately, it will become a matter of liability," Molly Joel Coye, head of the San Francisco-based Health Technology Center, said, adding, "We will consider hospitals not up to standard if they don't use systems like that." Brigham's system had a "$1.9 million price tag for design and installation" and costs about $500,000 per year to operate (Brown, Washington Post, 3/18).