Studies look at use, impact of computerized physician order entry

A recent study by the American Academy of Family Physicians found that a large number of mistakes are medication errors that could have been prevented with the use of computerized physician order entry systems.

The research, which was funded in part by the Agency for Healthcare Research and Quality, combined a 20-week study involving 42 family physicians at 42 practices with a 10-week study involving 401 clinicians and staff from 10 different medical offices.

The report, "Medication errors reported by U.S. family physicians and their office staff," found that of 1,265 medical errors, 194 were errors in medication. Seventy percent of the medication errors involved prescribing errors; 10% involved administration or documentation errors; 7% involved dispensing errors; and 3% involved medication monitoring errors. Researchers determined that more widespread use of health IT systems, such as CPOE and electronic medical records, could have prevented as many as 57% of the medication errors.

The study was published in the August 2008 Quality and Safety in Healthcare (link).

A separate report, "Moving Medication Safety to the Next Plateau," published in February by the Falls Church, Va.-based technology services company CSC, found that the pace of computerized physician order entry system adoption has grown, though not for what it considers all the right reasons (link).

The study said much of the progress that has been made has been in reaction to incidents or to meet regulatory requirements. Not enough attention has been paid to the entire medication use process, said David Troiano, principal consultant for the global health care sector of CSC, and one of the study's authors.

"What people are doing and what we find to be the biggest drawback is that it's been piecemeal. They don't think through the whole medication use process when trying to decide where to go next," Troiano said.

The American Hospital Assn. published a position statement in 2006 stating it is in support of the use of health IT in hospitals and agrees it plays a key role in improving quality and safety. The paper also acknowledges barriers to adoption, especially financial ones, and advocates increased Medicare payments to help offset ongoing costs.

The CSC study found that about two-thirds of hospitals with CPOEs are using clinical decision-support tools on their systems and that about half of those with CPOEs have deployed it hospitalwide. The report did not look at implementation in the ambulatory setting.