Leapfrog Group spawns CPOE systems testing
Leapfrog Group spawns CPOE systems testing
Move is third initiative for safety group
The Washington, DC-based The Leapfrog Group has engaged two organizations — First Consulting Group of Lexington, MA, and the Institute for Safe Medication Practices — to develop testing criteria and methodology for evaluating the effectiveness of hospitals’ computer-based physician order entry (CPOE) system implementations. The system, which should be ready by October, will be available to hospitals free of charge. (For The Leapfrog Group’s CPOE criteria and other facts and figures, see "The Leapfrog Group's CPOE patient safety standard," in this issue.) This is the third of the group’s initiatives to improve patient safety and quality of care; the other two are the delivery of intensive care by specialists and referrals to high-volume hospitals for common procedures.
"The way we chose our agenda was to go to all the leading patient safety gurus and say, If we wanted to come up with the health care equivalent of anti-lock brakes or seat belts, what would we do?’" explains Suzanne Delbanco, PhD, executive director of The Leapfrog Group. "We were told we should focus on things that would make a big difference in reducing medical errors, that were extremely well evidence-based, and that were extremely easy for the average American to understand," she says.
"If we say doctors have bad handwriting, which can lead to errors, and we can eliminate many of those errors by using computers, most consumers would respond, Why not?’ And in part, our initiatives should be consumer-driven. We also knew a lot of research is being done, and that the research today shows that CPOEs will make a big dent in reducing errors. Lastly, we needed to make sure that whatever initiatives we focused on would be easily ascertainable by outsiders."
Despite the fact that CPOEs have been shown to effectively reduce errors, fewer than 5% of the hospitals in the United States currently use such a system, according to Leapfrog. One of the major barriers, it notes, is cost.
Nevertheless, the need for greater accuracy in this area is clear. "The medication management process in hospitals is a highly manual and a highly complex process, and ripe for improvement in a variety of ways," notes Peter Kilbridge, MD, practice director for First Consulting Group. "Information management and medical management processes are so information-intensive that it makes them good targets for automation," he says. "The average physician ordering drugs needs to know not just that particular patient and his or her medical problems. The physician must also be aware of or be able to refer quickly to all drugs the patient is on, allergies, relevant lab data, and any diagnoses other than the one the patient has been admitted for. All of these have implications for dosing selection."
The task at hand
"Our job with Leapfrog is not just to compare systems; The Leapfrog Group’s desire is to incentivize hospitals to implement [CPOEs]; that is its specific intention," notes Kilbridge. "[It has] already indicated that it expects hospitals to implement our recommendations, so the next question is how to determine for the public at large whether a hospital has done what it says it would do . . . in a fashion that promotes patient safety."
Today, most of the systems that have been implemented don’t do that, Kilbridge continues. "So, The Leapfrog Group asked us to come up with a specific approach to evaluating — to design a test approach — to help hospitals evaluate and report the way their system is implemented and used, and if it actually accomplishes the kind of high-value decision support required for patient safety.
"In other words, we will try to come up with a test methodology and specific orders so that hospitals will be able to qualify for the Leapfrog criteria," he says. "Our approach is based on using the available data in the field to help us further determine what those criteria are, and to help hospitals move in that direction. As much as possible, they will be based on the current literature."
"First Consulting will enable us for the first time to make the effectiveness of a CPOE system more transparent," notes Delbanco. "For example, we’ll be able to determine what proportion of serious errors the system is intercepting. We want be able to create a test that makes the system more transparent to consumers as well. It also will be used by hospitals for their own QI purposes," she points out. "They will have a standard methodology for assessing a lot of system components — checking for drug/drug interaction, whether it catches patient allergies, if dosages are correct for patient height and weight, lab values, and so on. It will report specifics — and it will be very, very technical."
Getting others to take action
The Leapfrog Group’s goal, of course, is to reduce serious medical errors; to do that, it must encourage health care facilities to follow its recommendations. "We don’t want to be overly prescriptive," says Delbanco, "but the CPOE is the most effective way we know of reducing errors today. We won’t specify what software to buy, or how the equipment should be programmed; there isn’t one obvious leader. But we do want hospitals to put in effective systems."
According to Delbanco, the way to enhance compliance is to encourage patients to choose hospitals that have CPOEs, and encourage more hospitals to put systems in place. "I think most of the leverage will occur at the local level," she says. "On the national scale, there’s no doubt we have had an impact. We believe it’s really about providing a business case [for CPOEs]. We will have a report coming out in few weeks on the economic implications of all three of our initiatives, which will include research on costs, savings, and to whom they accrue — the hospital, the insurer, and so on," Delbanco says. "There will be some really good returns on investment reported."
Also, she notes, all of the organization’s members (which include many members of the Fortune 500) have agreed to recognize and reward hospitals that meet Leapfrog standards. "It may be a blue ribbon award that can be used in marketing campaigns to channel enrollees, or higher reimbursement rates," notes Delbanco. "Those decisions will be informed by discussions between hospitals and employers. In some markets, hospitals want more patients, while in others, they want higher reimbursement."
Need more information?
For more on computer-based physician order entry, contact:
• Peter Kilbridge, MD, Practice Director, First Consulting Group, 55 Hayden Ave., Suite 3100, Lexington, MA 02421. Telephone: (781) 402-2520.
• Suzanne Delbanco, PhD, Executive Director, The Leapfrog Group, c/o The Academy, 1801 K St. N.W., Suite 701-L, Washington, DC 20006. Telephone: (202) 292-6711. Fax: (202) 292-6813. E-mail: [email protected].
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