After studying clinician usage of a vintage computer physician order-entry system at one hospital, researchers concluded "a leading CPOE system often facilitated medication error risks, with many reported to occur frequently."
I believe this study, published in March 9 issue of the Journal of the American Medical Association, can be compared to researching a 1970's model Ford Pinto and concluding that all cars are in danger of blowing up. Given the interest this study has generated, it's important to understand the study's deficiencies and articulate the benefits of CPOE.
The study is based on one hospital and one rudimentary CPOE system that isn't sold today. This is not a study about errors, but one about potential errors. It did not measure actual errors or adverse events; neither did it compare paper-ordering errors to those made using CPOE. It identified 22 "errors," which actually were process issues, not real errors.
As a physician at Childrens Hospital Los Angeles, I understand the limitations of a disjointed system without a connection to the pharmacy -- an incredible risk, especially in pediatrics where we deal with meticulously calculated weight-based medication dosages. This is why we implemented the CPOE solution from Cerner Corp., which includes a closed-loop medication process. The potential for increased patient safety through an integrated CPOE system is undeniable. Anything less than a closed-loop medication process is unsafe.
A unified CPOE solution addresses all 22 process issues listed in this study. In fact, our CPOE system, which processes approximately 1,500 electronic orders each day, has delivered real benefits, including increased patient safety. We also created more than 125 order sets, resulting in potential errors being automatically detected through rules, weight-based dosing, drug interaction checking and appropriate order sentences for medications. Additionally, regulatory compliance has improved, as the percent of verbal orders signed off within 24 hours has increased dramatically.
Finally, a CPOE system is about more than just integration -- it is about improving the quality of our patient care. It provides the ability to see clinical information in one place -- anytime, anywhere. A number of physicians have told me that, as a result, they know their patients better now than they did before.
We all should be looking at unified CPOE systems that ensure errors described in this study don't occur.
Sajjad Yacoob, M.D., director of Medical Informatics, Childrens Hospital Los Angeles