Can you afford not to computerize med orders?

Study: Costs of ADEs outweigh technology costs

Few hospitals say they can afford the costs of computerizing physician order entry, including medication ordering. A recent report issued by the Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD, however, indicates that hospitals are paying a far higher price to avoid the technology.

The report estimates that more than 770,000 people are injured or die each year in hospitals from adverse drug events (ADEs), which may cost up to $5.6 million each year per hospital depending on the hospital size. Patients who experienced ADEs were hospitalized an average of eight to 12 days longer than patients who did not suffer ADEs, and their hospitalizations cost $16,000 to $24,000 more.

Get that system up and running

The AHRQ report found that implementing computerized medication order entry systems would be a tremendous benefit to hospitals, with the potential of preventing an estimated 84% of dose, frequency, and route errors. In addition, the systems also could prevent anywhere from 28% to 95% of ADEs, the report says. Overall, hospitals could save as much as $500,000 annually in direct costs by using the systems.

One health care facility is saving millions. Brigham and Women’s Hospital (BWH) in Boston spent about $1.4 million in the mid-1990s on a rules-based clinical information system developed by Eclipsys Corp. in Delray Beach, FL. BWH is the flagship facility of Partners HealthCare System and is a teaching hospital affiliated with Harvard Medical School. BWH also spends about $500,000 in yearly system maintenance fees, according to numbers given by the Institute for Safe Medicine Practices (ISMP) in Huntingdon Valley, PA.

The overall cost savings from the system, however, is estimated to be between $5 million and $10 million a year, says Gilad J. Kuperman, MD, PhD, director of clinical systems research and development for Partners HealthCare System. The system alerts physicians to problems such as drug-to-drug and drug-to-food interactions, patient allergies, wrong doses, and duplicative lab and other tests. "There has been some reduction in the use of medication of renal failure because lowered doses are necessary," he adds. "There are also more appropriate uses of less expensive medications and reduced adverse drug events."

Kuperman says that with the introduction of the system, BWH has documented a 55% reduction in serious medication errors and an 81% reduction in non-missed dose medication errors overall. Studies also have shown that nearly 400 times a day, physicians at BWH change a medical order based on information that the system provides them at the time of order placement.

Not only has the system reduced medication error rates, but it has changed the role of BWH pharmacists, as well, Kuperman says. First, the medication orders are received on a computer terminal and are legible. "The orders are more complete," he explains. "They have already gone through one round of computerized checking at the physician level. If the physicians have taken any actions, then the pharmacists are aware of that."

There also is a link from the ordering system to the inpatient formulary. "Some of those links are made automatically," says Kuperman. Verbal communication between the pharmacists and other medical staff has dropped tremendously due to the increase in electronic communication, too.

Although the figures show that pharmacists, patients, and the entire health care system can benefit from using the technology, Kuperman says that each facility must decide how the technology fits into its overall patient safety strategy. "If an organization is going to consider this kind of initiative, it has to understand why it is doing it and how it fits into everything else it is doing." 

Sources

The Agency for Healthcare Research and Quality (AHRQ) in Rockville, MD. Telephone: (301) 594-1364. Web site: www.ahrq.gov.

Gilad J. Kuperman, MD, PhD, director of clinical systems research and development for Partners HealthCare System, Boston. E-mail: gkuperman@partners.org.