Globe editorial on CPOE
Computerize the errors away
February 21, 2008
Second in a series
PREVENTING MEDICATION errors in Massachusetts hospitals could save $170 million while sparing patients the ill effects of these mistakes. The best protection against errors is to computerize doctors' orders for drugs and tests. The 63 hospitals in the state that have not taken this step - only 10 have - should do so as quickly as possible.
That is the aim of an initiative led by the Massachusetts Technology Collaborative and the nonprofit New England Healthcare Institute. In a study of six community hospitals, researchers found that 10 percent of patients suffered from a preventable medication error. Fortunately, none of the errors caused a patient's death.
The researchers also looked for - and found - examples of other costly missteps that could be avoided with computerization: the use of more costly drugs when cheaper ones are available; the use of the intravenous version of a drug even though a patient can handle its less expensive oral form; the administration of drugs to patients whose kidneys cannot handle them; and ordering redundant tests.
Although the benefits of computerized orders have been evident for several years, hospitals have been slow to switch from handwritten orders. The initial costs are high, and many doctors, especially older ones, are resistant to change. According to a report released by the initiative last week, computerization would cost an average hospital about $2.1 million. The annual operating cost would be $400,000. But the report said the average hospital could save as much as $2.7 million annually. It estimated a payback period of 26 months.
Figures like these should push the 63 hospitals toward computerization. To encourage them in that direction, the state's largest insurer, Blue Cross Blue Shield of Massachusetts, has said it would make hospitals that have not computerized in four years ineligible for payments from the insurer's incentive program for promoting quality care.
Dr. JudyAnn Bigby, the state's secretary of health and human services, is exploring the possible use of a state trust fund to help hospitals computerize. State Senator Richard Moore, chairman of the Joint Committee on Healthcare Financing, wants the state Board of Registration in Medicine to require that all physicians seeking a new license or a renewal show that they are proficient in the computerized ordering system.
Massachusetts has embarked on a healthcare reform that holds out the promise of coverage for virtually all the state's residents. But the state is already finding the cost is higher than expected. This puts a premium on finding and implementing cost-cutting measures that do not lower quality. Computerization of doctors' orders in hospitals cuts costs and raises quality. This win-win program should top every hospital's to-do list.