Safety first: IT has made huge inroads into improving patient safety Four healthcare end-users discuss their organizations' latest IT adoptions of patient safety technologies - Patient Safety - Cover Story

Health Management Technology, Feb, 2004 by Richard R. Rogoski

While securing patient information has grabbed the spotlight in recent years, ensuring patient safety is still a priority for physicians, nurses and CIOs.

Medication errors have been addressed publicly by the Institute of Medicine and by the Joint Commission on Accreditation of Healthcare Organizations, which recently issued more stringent guidelines covering the way drugs should be ordered and patients identified. New technologies, available for use at the point of care, are also becoming more popular with clinicians and are assuming a larger role in the strategic planning of healthcare organizations.

CPOE: Safeguarding Orders

Physicians at Loma Linda University Medical Center in Loma Linda, Calif., have been actively and enthusiastically involved in rolling out a computerized provider order entry (CPOE) system, slated to go live in April, says Bob Blades, vice president and CIO. "We have 580 residents, and in an academic medical center, about 80 percent of orders are written by residents. They're comfortable with computers and eager to get the automated support. But we're cautious. We want to make sure CPOE adds value to their work and doesn't slow them down. When we started, it was too slow and too complex, and we thought it wasn't going to work. But we listened to physicians' feedback, and kept customizing and simplifying it for them."

Blades says it was never the intent to turn physicians into unit secretaries, but to improve workflow, streamline processes, and provide more input and access at the point of care. "In a hospital, the bedside is where patient care occurs, so it must also be where documentation and orders occur." He says Loma Linda physicians want to use the CPOE system, and "we have taken the time to make sure it works the way they want it to work."

Yet for Loma Linda, which boasts 265 ICU beds out of a total of 800, choosing Cerner's PowerOrders CPOE was "the icing on the cake," says Blades. The organization implemented a five-year strategic plan in 1997 and targeted the clinical side of healthcare as its top priority. "CPOE figured early on to play a big role, but it was only one piece of the pie," Blades says.

In 1997 and 1998, Loma Linda inventoried its systems, partly in response to the Y2K threat. In doing so, the organization determined which systems could be modified and which needed to be replaced. The organization updated the plan again in 1999.

In the course of upgrading, Loma Linda replaced its old radiology system with a new radiology management system, implemented a Web-based PACS, rolled out a new laboratory information system in 2002 and is currently installing a new pharmacy system--all with the goal of creating an easily accessible repository of digitized information and decision support capability. "CPOE is the piece that makes the whole system fit together," Blades says. "We had to make the pieces fit so clinicians would want to access information digitally, especially at the bedside."

One of the biggest benefits of the new CPOE will be felt in the pharmacy. Loma Linda had a third-party pharmacy system that it wanted to replace, but it chose to wait for the new Cerner Millennium system, knowing that fully integrated pharmacy and CPOE systems made more sense than interfacing a new CPOE to the old pharmacy system.

Customized for Physicians

Ensuring patient safety and reducing potential errors figured prominently in Loma Linda's decision to purchase and implement CPOE. "When we started, we set up quality initiatives," Blades says. "We developed five that we knew the CPOE system had to meet: It should improve patient safety, it should improve access to care, it should be cost-effective, it should improve our patient/customer satisfaction scores and it should improve our clinical outcomes."

Return on investment was not a major consideration when purchasing the CPOE. "We put ROIs on the radiology, lab and pharmacy systems, as well as clinical data capture," Blades says. But CPOE by itself translates into improving quality of care rather than saving money, he notes.

The choice of Cerner's PowerOrders system also provided Loma Linda with the features it was looking for. The product's evidence-based diagnostic and treatment knowledge, along with patient and plan information, is readily available at the bedside. Since orders and charges are captured at the point of care, there are also fewer lost orders and legibility issues.

The system has built-in safeguards. Alerts and reminders allow clinicians to avoid duplication of orders or potential problems caused by allergy, food or drug/drug interactions. Its constant clinical monitoring feature allows doctors and nurses to access, in real time, clinical data from other departments that could affect ordering decisions. Dosing errors also are reduced through the system's dose range checking and complex dosing features.

One feature which physicians especially like is the system's pre-built order sets, which allow them to move quickly through the ordering process. Since all ordering is done in real time, associated tasks are automated so that all appropriate clinicians and departments are immediately notified when an order is written.