Computerized systems meant to limit drug mishaps routinely fail to detect harmful and even fatal medication orders, according to a new report from the Leapfrog Group.
Computerized provider order-entry systems failed to flag nearly 2 out of every 5 incidents where the wrong drug was prescribed, the incorrect dosage was requested or follow-up reminders failed to appear.
“Hospitals spend millions of dollars to implement CPOE systems, but our results clearly show that many … are not operating as well as they should,” Leapfrog Group CEO Leah Binder said in a news release about the survey results. “Mistakes are still seen with far too much frequency.”
The not-for-profit healthcare quality improvement organization surveyed 1,750 U.S. hospitals on their use of CPOE technology and the data was analyzed by the health information technology vendor Castlight Health.
Hospitals first started feeling pressure to install the systems (PDF) in the early 2000s, fueled by the release of the Institute of Medicine's seminal To Err is Human report, which galvanized the patient safety movement in the U.S.
The technology moved clinicians away from using paper to order medications, lab tests and scans. The software can alert physicians to medication conflicts, identify patients' potential allergic reactions and incorporate evidence-based guidance and recommendations.
While only 384 hospitals reported using computerized medication ordering systems in 2010, the number jumped to 1,300 in 2014, according to previous Leapfrog estimates. Nearly all hospitals reported using CPOE in 2015.
The widespread adoption is attributed in large part to the federal incentives for using electronic health records. As of October 2015, more than 479,000 healthcare providers received payments for participating in the CMS' EHR incentive programs.
Providers could also have their payments cut for failing to meet the requirements of the programs, which include CPOE. The penalties start at 1% and steadily increase each year that meaningful use of the technology is not demonstrated. The maximum is 5%.
While the CPOE technology has proved beneficial, it is not devoid of challenges. These include usability issues, such as the potential for selecting the wrong item from drop-down menus or having too many alerts, which providers soon realize they can override.
Also, the benefits are not uniformly distributed. Participation in the EHR incentive programs is lower for physicians than for hospitals, and only 57% of accountable care organizations reported having CPOE systems.
To test the effectiveness of hospitals' CPOE systems, facilities participating in the Leapfrog survey were given a list of orders to enter, some of which contained information that could have been harmful if actual patients had been involved.
The systems failed to flag 39% of potentially harmful drug orders and 13% of potentially fatal ones. The most common issues missed were related to wrong medications and wrong dosages.
The report also found regional differences. Leapfrog urges hospitals to order at least three-fourths of their medications using the CPOE systems and establish protocols that alert physicians to at least half of the most common prescribing errors.
Indiana and Nevada had the lowest percentages of hospitals meeting those standards, while hospitals in Maine, Georgia and New York were at the top.