Computerized scripts could reduce errors

Medical errors could be reduced dramatically in U.S. hospitals through the use of computerized prescription monitoring systems, according to a Harvard Medical School official. He predicts the systems could save tens of thousands of patients’ lives each year.

The systems have proven their worth at Harvard. David W. Bates, MD, the chief of general medicine at Harvard’s Brigham and Women’s Hospital in Boston, says computerized physician order entry (CPOE) systems have helped two Harvard hospitals more than halve their prescription error rate and saved the facilities between $5 million and $10 million.

For any health care provider interested in cutting down medical errors, "This is something that should be in everybody’s long-term vision," Bates says. He made his comments at a recent meeting of the National Committee for Quality Health Care in Washington, DC.

A report from the Institute of Medicine indicates that prescription errors are thought to account for at least 20% of the total patient deaths that occur in the United States each year, which is between 44,000 and 98,000. CPOE systems can reduce errors by storing detailed databases of all drugs doctors might order for patients. The computer system flags potentially dangerous drug interactions and also prevents physicians and pharmacists from accidentally ordering or delivering drugs in the wrong amounts. The system also is sensitive to similarly named drugs that can confuse providers anywhere along the medical chain of command. A computerized system also can eliminate the hazards posed by doctors’ illegible handwriting.

Despite those potential benefits, health care facilities have been slow to adopt the technology because it can be expensive and imperfect. But Bates says Harvard’s $2 million CPOE system, under development since 1993, helped cut the error rate from 140 prescription errors to 25 errors per 100 patient-days. "It’s just an extraordinarily powerful tool," he says.

California law calls for all urban hospitals in the state to implement CPOE systems by 2005 and to have plans for implementation by 2002. The law gives no extra money to hospitals to pay for the systems, according to Bates. CPOE proponents would like Congress to offer federal tax credits or other incentives to hospitals that purchase the systems in the name of increasing patient safety.