CPOE cuts time needed to deliver meds, X-rays

Turnaround times are reduced by as much as 64%

A new study suggests that hospitals may be able to significantly cut the time it takes to deliver medications to patients and complete X-rays and lab tests by using computerized physician order-entry (CPOE) systems.

The study, which recently appeared in the Journal of the American Medical Informatics Association, showed that computerized ordering also eliminated prescription drug errors that occurred when physicians’ handwritten prescriptions were misread.

The study found that computerizing physician orders slashed medication turnaround times by 64%, cut turnaround times for X-rays and other radiology procedures by 43%, and reduced turn-around times for lab tests by 25%.

Overall, CPOE seems to be good for both patients and hospitals, says Hagop Mekhjian, MD, the study’s lead author and chief medical officer for The Ohio State University’s health system, in Columbus. "We found that it enhances patient care by improving work flow and efficiency and by reducing transcription errors," Mekhjian notes, adding that the hospitals initially invested about $5 million in the program.

Even at that cost, however, introducing a CPOE system wasn’t a real burden for Ohio State’s health system, he contends. "There weren’t any significant negative results, despite the major cultural change that stemmed from introducing this new technology. In many cases, work flow accuracy and efficiency were actually enhanced," he says.

Researchers compared turnaround times before and after the implementation of the CPOE at Ohio State University hospitals. (The university has been using CPOE in some inpatient units for nearly three years.) The data were collected from patient charts and also from watching physicians as they prepared written orders. After the CPOE was in place, the researchers gathered the same type of data electronically. They tracked the amount of time physicians spent on rounds; how long it took to write an order; what time an order was written; and when the order made it to its intended destination, such as the pharmacy or the laboratory.

The researchers also measured three events:

  • medication turnaround times (how long it took for a patient to receive a prescribed medication);
  • the amount of time it took to complete a radiology procedure;
  • how long it took for a laboratory to post-test results.

Medication turnaround times decreased from nearly 5½ hours to just under two hours; radiology procedure completion times dropped from slightly more than 7½ hours to four hours and 21 minutes; and laboratory result reporting times decreased from 31 minutes to 23 minutes.

"We didn’t expect such significant changes," says Mekhjian.

When the CPOE was combined with another electronic system that completely eradicated all manual transcriptions, the researchers found that medication errors were eliminated.

"Total elimination of transcription leaves little room for errors associated with the interpretation and translation of doctors’ orders," Mekhjian observes.

As many as 25% of reported medication errors arise from confusion over the similarity of drug names, according to the National Coordinating Council for Medication Error Reporting and Prevention.

"This is especially true when a doctor gives the orders verbally to a nurse or directly to the pharmacy," Mekhjian adds. But the greatest advantage of CPOE, he says, is the way it can speed up patient care in many cases. Previous studies reported that up to one-third of all hospitalized patients experience some kind of delay in their care, with the average length of a delay being nearly three days. "There can be delays in decision making while a physician waits for results, delays in scheduling diagnostic tests, and delays in discharge planning," Mekhjian explains.

"Entering an order into a computer can help alleviate many of these delays. It also serves as a check-and-balance system to doctors, such as reminding a physician if a prescription needs to be countersigned," he says.

While CPOE helped with order turnaround times, the study showed that it had little impact on hospital costs and stays. The length and cost of stay decreased in a few surgical areas, but overall results were not significant.

"Stay and cost are affected by a number of things beyond the scope of this study," Mekhjian explains.

Although the current study focused solely on inpatients, he says that Ohio State is looking into using the system in outpatient clinics.

"That’s a priority for us," he notes. "The outpatient population is considerably different — there is greater diversity among patients’ needs, and things move a lot faster."

For more information, contact:

• Hagop Mekhjian, MD, Chief Medical Officer, The Ohio State University Health System, Columbus, OH. Telephone: (614) 293-8158. E-mail: Mekhjian.1@osu.edu.