Rhode Island’s largest hospital network has eliminated virtually all handwritten
prescriptions and other doctors’ orders in place of computers, leading a national
trend aimed at curbing medication errors.
Lifespan’s four acute care hospitals, including Rhode Island Hospital, changed the way it processes doctors’ orders earlier this year, a process that will be completed in the fall. Only 10 percent of American hospitals have adopted the “computerized physician order entry” system, based on an American Medical Association survey earlier this year.
The number of medication errors in U.S. hospitals increased by 82 percent in 2002, according to a report produced by U.S. Pharmacopeia. The American Medical Association reported that the CPOE system has been shown to reduce medication errors by 55 percent.
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“We believe the medical statistics that show technology makes a safer environment, and we are aggressive in our pursuit,” said Carole Cotter, senior vice president and chief information officer of Lifespan.
CPOE, which is not mandated by the federal government or states, has been slow to catch on due to cost. However, hospitals that have adopted the procedure say the initial expense will save money and protect patients in the long run.
Lifespan began implementing the system as part of a more than $50-million technology master plan dating back to 1996.
CPOE is up and running in 90 percent of Rhode Island Hospital and Hasbro Children’s Hospital as of May. At Newport Hospital, it went live on all units in June. At The Miriam Hospital, CPOE is available in critical care units and should be implemented on all patient floors this fall, said Nicole Gustin, Lifespan media relations manager.
“The major impact of this system is that illegible orders no longer exist in the charts in Rhode Island Hospital,” said Dr. Mitchell Levy, director of critical care at the hospital.
The system sends physician orders directly to the pharmacy or laboratory, for example, instead of orders being written down and sent through an intermediate, like a desk clerk or nurse, cutting down on order processing time. Physicians also receive laboratory and diagnostic test results on the system the instant they are ready.
If the computer system were to go down, patient care would not be in jeopardy because the hospital could revert to paper as a backup system, Levy said.
The system can also assist the physician at the time of ordering by suggesting appropriate doses and frequencies, displaying relevant laboratory data, and screening orders for allergies and drug-drug and drug-laboratory interactions. It also contains a “rules” engine that looks for drug-allergy interactions, drug-drug interactions and duplicate drug orders to cut down on possible medication errors.
The CPOE system at Lifespan hospitals is interfaced with the hospitals’ electronic medical records system, Lifelinks, which allows doctors to view X-rays, MRI and CT scans on a high-resolution screen.
Medication errors can happen in hospitals during ordering, dispensing and administering a medication. While most errors are minor, a small proportion result in injury or an “adverse drug event.” One in 100 medication errors and about seven per 100 have the potential to do so, the Journal of the American Medical Informatics Association reports. The journal also wrote that nationally the cost related to medication error to hospitals is approximately $2 billion.
So few hospitals have implemented CPOE because of cost, the American Medical Association reports.
“This is a very expensive system. We are fortunate to have an affiliation with Lifespan, because most community hospitals like (Newport) could never afford this,” Dr. Terry McWilliams, vice president for medical affairs at Newport Hospital, said.
Adapting to a new system also deters hospitals from implementing it, the AMA reports.
“It takes a bit longer to log in and fill out all the required fields than it would to open up a chart and write down some orders. That few seconds can seem like an eternity to doctors and nurses who are pressed for time, but patient safety and the speed in which it reaches the source we hope will balance that individual frustration,” McWilliams said.
Care New England Health Systems, the state’s other large hospital group, is in the process of investing in the CPOE system as part of a strategic development plan currently under way. Over the next two years, the system will be implemented in all of Care New England’s hospitals, which include Butler Hospital, Kent Hospital and Women & Infants Hospital, Chief Medical Information Officer Cedric Priebe said.
“We are moving quickly toward implementing this system because we see how important it is to patient care and efficiency,” Priebe said.
