An interesting article on reducing medical errors in hospitals appeared in the Philadelphia Inquirer today. In the article, it is stated that:
A regional effort to prevent hospital patients from being harmed by medication errors has made progress, but more must be done, according to a new report. Launched in February 2001 by the Delaware Valley Healthcare Council and two leading patient-safety organizations, the Regional Medication Safety Program for Hospitals sought to give hospitals the tools needed to reduce mistakes that injure and kill patients. A report on the program being released today concludes that participating hospitals had a 22 percent improvement toward meeting the council's goals.
The article describes the metrics used to arrive at the 22% improvement figure, and goes on to state:
"The implementation of computerized medication orders will reduce errors between 60 and 95 percent when the appropriate pharmacy safeguards are in place," said John J. Kelly, chief of staff at Abington Memorial Hospital. Abington has required that all medical orders be entered in the computer since the system was fully implemented at the Montgomery County hospital three years ago.Disclaimer: Dr. Jack Kelly was my Medical Residency Program Director. He is a superb clinician and in his new role as Chief of Staff, I am certain he will make major strides in quality improvement at Abington Memorial, a truly excellent hospital already.
One problem with such information systems is the cost. Kelly said Abington spent more than $30 million on its project. Thomas Jefferson University Hospital spent $20 million, not including the training and ancillary costs. Main Line Health is in the midst of a 5- to 10-year, $21 million project to add computerized order entry at its three hospitals and its rehabilitation facility. In this region, about one-quarter of all hospitals have such systems. Leapfrog [the Leapfrog Group business consortium] found that 4.4 percent of the nation's 1,257 hospitals that responded to its survey have computerized order entry.
My concern is on implementation costs of these POE (physician order entry) systems. In my website "Common Examples of Health IT Failure" I wrote about some of the factors that cause costs to spiral and projects to encounter costly difficulty and even failure. Factors such as inadequate IT personnel and management consultant experience in complex clinical environments, vendor overpricing and sweetheart ("padded") deals, political and territorial infighting, and poor relations between clinicians, IT staff and hospital executives are examples.
The AMA case study "Doctors Pull Plug on Paperless System" is a poster-child example of these problems. (My response from the medical informatics perspective, "How to Avoid CPOE Failure a Second Time" , appeared in the journal Health-IT World). Unfortunately, there are no metrics to robustly determine whether or not hospital IT staff (usually of a business-IT and not clinical-IT background) are performing in the most cost-effective manner, and/or if hospitals are getting "fleeced" by information technology companies and healthcare IT management consultants.
I suspect they often are, and have seen it in my own experiences. This is an issue that should be addressed before the remaining 78% of the "quality improvement gaps" are addressed. Hospitals, of all organizations, have precious little extra capital and expense in their budgets to pad the incomes of healthcare IT companies, IT vendors and management consultants.
I should also add that the "22% improvement" figure is disappointing considering the time, expenditures, publicity, public pressures, and other factors at play in the hospital/healthcare sector five years after the Institute of Medicine (IOM) landmark 1999 report, "To Err Is Human", which cited 98,000 preventable deaths each year.
-- SS
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