One of the strongest proponents of computerized physician order entry is the Leapfrog Group, a Washington, D.C.-based organization of more than 100 businesses, including Fortune 500 companies.
Founded in 2000 by the Business Roundtable, an association of CEOs also that is based in Washington, its goal is "to trigger a giant leap forward in quality, customer service and affordability" for healthcare consumers.
Leapfrog chose CPOE as a key hospital quality improvement initiative after asking, "What would be the equivalent of antilock brakes, airbags and seatbelts in the medical world?" says Leapfrog Executive Director Suzanne Delbanco.
CPOE costs several million dollars per hospital to install, so the group knows it has an uphill climb. Of the 435 hospitals nationwide surveyed so far by Leapfrog, Delbanco says only 21 have fully implemented CPOE.
Leapfrog embraces two other patient-safety measures for hospitals: use of intensivists in ICUs and outcomes measures for certain conditions, with the goal of using hospitals with the best outcomes.
But these are less effective strategies, according to John Halamka, M.D., chief medical information officer at CareGroup HealthCare System, a six-hospital Boston integrated system with 3,000 doctors and CPOE. "CPOE is the single most important way to reduce medical errors," he asserts.
He says a study of a CPOE system at Brigham and Women's Hospital in Boston found it reduced the error rate there by 55%, and further improvements in the system reduced the rate even more.
Meanwhile, Delbanco hopes to nudge hospitals toward use of the three Leapfrog standards by reporting hospital compliance on Leapfrog's Web site and on those of other organizations, such as doctorquality.com.
Leapfrog has asked hospitals to voluntarily report compliance with its three standards in 19 urban and suburban areas, including Massachusetts, New Jersey, California, New York City and Seattle. In addition, New York City-based Empire Blue Cross Blue Shield will pay hospitals a 4% bonus if they meet Leapfrog's CPOE and ICU staffing standards, starting this year.
Somerset Medical Center, a 355-bed hospital in Somerville N.J., is one of the hospitals on the CPOE bandwagon, but it made its decision before the Leapfrog initiative started, says William Cors, M.D., senior vice president for medical affairs.
In addition to raising quality, the new $5 million CPOE system should make his hospital more competitive and lower its malpractice insurance rates, Cors says.
To meet its CPOE standard, Leapfrog says hospitals must:
- Require physicians to enter medication orders on computers linked to prescribing and error-prevention software.
- Demonstrate that their systems have intercepted at least 50% of common serious prescribing errors.
- Require physicians to give reasons each time they override any of 1,000 or so alerts on possible errors.
Leapfrog also offers hospitals a guide to CPOE vendors, a list of clinical decision support tools and advice on what to consider when selecting a vendor.