Medical error reduction: It comes at a high price
Do outcomes outweigh the technology’s cost?
Few hospitals say they can afford the costs of computerizing physician order entry. A recent report issued by the Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD, however, indicates that hospitals are paying a far higher price to avoid the technology.
The report estimates that more than 770,000 people are injured or die each year in hospitals from adverse drug events (ADEs), which may cost up to $5.6 million each year per hospital, depending on hospital size. Patients who experienced ADEs were hospitalized an average of eight to 12 days longer than patients who did not suffer ADEs, and their hospitalization cost $16,000 to $24,000 more on average.
The AHRQ report found that implementing computerized medication order entry systems would be a tremendous benefit to hospitals, with the potential of preventing an estimated 84% of dose, frequency, and route errors. In addition, the systems also could prevent anywhere from 28% to 95% of ADEs, the report says. Overall, hospitals could save as much as $500,000 annually in direct costs by using the system.
One health care facility is saving millions. Brigham and Women’s Hospital (BWH) in Boston spent about $1.4 million in the mid-1990s on a rules-based clinical information system developed by Eclipsys Corp. in Delray Beach, FL. BWH is the flagship facility of Partners HealthCare System and is a teaching hospital affiliated with Harvard Medical School. The Brigham also spends about $500,000 in yearly system maintenance fees, according to numbers given by the Institute for Safe Medicine Practices in Huntingdon Valley, PA.
The overall cost savings from the system, however, is estimated to be between $5 million and $10 million a year, says Gilad J. Kuperman, MD, PhD, director of clinical systems research and development for Partners HealthCare System. The system alerts physicians to problems such as drug-to-drug and drug-to-food interactions, patient allergies, wrong doses, and duplicative lab and other tests. "There has been some reduction in the use of medication of renal failure because lowered doses are necessary," he adds. "There are also more appropriate uses of less expensive medications and reduced adverse drug events."
Kuperman says that with the introduction of the system, BWH has documented a 55% reduction in serious medication errors and an 81% reduction in non-missed dose medication errors overall. Studies have also shown that physicians at BWH change a medical order nearly 400 times a day based on information the system provides them at the time the order is being placed.
The benefits of using an automated medication ordering system are felt on the individual level, as well. "It is the way of the future, from an accuracy standpoint," says Kathy Rose, CRNH, of St. Paul’s Hospice in Dallas. Rose first loads patient information onto the Internet through a secure network. Then she can pull up the information via desktop, WebPad, or Palm VII wireless PDA, and can order patients’ medication off-site at any time. "I can sit in my car and transmit my prescriptions after I am out of the [patient’s] house and I know the prescriptions are accurate," she says. She can also access the system’s clinical databases, which include an on-line Physicians’ Desk Reference, disease treatment protocols and care plans, and normal lab values that act as references and are not patient-specific.
When Rose orders patient medication, the directions she has typed into the system come back on the screen and show what she has just ordered. "There are two different times before I transmit the prescription to confirm that this is the way it is supposed to be written," she says. Rose then e-mails the medication order to the pharmacy’s fax machine, with the patient’s name and address and the physician’s license information printing on the prescription. "When I transmit it, [the system] tells me the doctor’s name and that it was transmitted by me, which makes it legal," she says. The prescription the pharmacy receives from her is typed and legible.
Connecting providers in real time
Pharmacists understand the importance of the technology too, Rose says. "One of the pharmacists [who receives prescriptions] marked his calendar when I first transmitted him one."
Once Rose has loaded her medication information, other health care providers can access the information through the server. This was a primary reason for the development of the technology, say executives of Dallas’ Park Pharmacy Corp., developers of this Rx-Pro technology. There is a need in the medical field to connect pharmacists, doctors, and nurses in real time, allowing each group to interact with one another simultaneously for the common goal of improving patient care, they say. Unlike the system used by BWH, Rx-Pro is an application service provider. Instead of purchasing the system, Rx-Pro users subscribe to the service and pay a minimal monthly fee.
Providers need to understand that using new technology is just one way of improving patient safety, Kuperman says. "If you are going to do this, one of the most important success factors is to understand where it fits into your overall patient safety strategy." For example, senior leadership must be behind the decision to use the technology and understand its benefits and goals. Physicians also must be kept informed. "All of these are important success factors," he says.
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