Although a new study finds "uneven" effort being applied to implementing clinical decision support in CPOE, some hospitals are setting the bar for its use. This is good news that should not be overlooked, says one of the authors of the study.
The study of 62 hospitals, which was published in the policy journal Health Affairs, found that individual hospitals scored anywhere from 10 percent to 82 percent on the ability of the implemented decision support to detect and inform physicians about test orders that would cause an adverse drug event if the medication reached the patient.
For the top performing hospitals, which represented 10 percent or six hospitals, performance scores ranged from 71 percent to 82 percent. The six lowest scored hospitals had scores from 10 percent to 18 percent.
The hospitals were evaluated using The Leapfrog Group’s CPOE evaluation tool, which “mimics” what happens when a physician writes an order in an EHR with CPOE and measures the ability of the technologies to avert prescribing errors.
The Leapfrog Group has established a standard for hospitals that requires physicians and other licensed providers to enter at least 75 percent of medication orders electronically and requires that they demonstrate that their clinical decision support can alert physicians to at least 50 percent of common, serious prescribing errors.
Leah Binder, CEO of the healthcare watchdog group finds the results of the study “disturbing.” She says a “clear as day” take away from the study is that hospitals should be monitoring the effectiveness of the technology.
Implementing CPOE is one of the requirements for Stage 1 meaningful use eligibility. Stage 1 requires providers to enter at least 10 percent of all orders using a CPOE system.
“Setting expectations for how the EHR is used through meaningful use is a good thing,” says Jane B. Metzger, principal, emerging practices at Falls Church, Va.-based research and consulting firm CSC. “Meaningful use guides the hospital to what the implementation should look like. This study shows that those expectations should include active use of clinical decision support to help ensure that progress continues in achieving national goals such as improving patient safety."
NorthBay Healthcare, with hospitals in Fairfield and Vacaville Calif., recently deployed evidence-based and experience-based clinical decision support technology to comply with meaningful use requirements. The expectations are high.
"With evidence-based medicine the patient is getting the best practice care delivered at the point of care,” said Donald Denmark, MD, vice president of medical affairs at NorthBay. “This is what gives the best outcome; this is what gives patients shorter lengths of stay. This is what reduces the frequency of testing in certain areas. And this is what optimizes medical management.”
Binder calls for the monitoring CPOE as part of demonstrating meaningful use because if it is not monitored, she says, it becomes useless.
In June, The Leapfrog Group will be posting the results of about 200 hospitals that have taken the CPOE evaluation test.
Currently, Binder says, only 9 percent of all hospitals meet Leapfrog’s standard for CPOE.
