A high-tech transfusion for Mass. hospitals

By Mitchell Adams and Wendy Everett

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A PHYSICIAN decides to order stronger pain relief medication for her 56-year-old patient hospitalized for a badly broken ankle. Like many people today, the patient is taking other prescription drugs, in this case for high blood pressure and a brand-new drug for anxiety. The doctor types her order for the stronger pain medication into a new computer, and immediately a red flag pops up alerting her that the dose is much too high. The fictional patient in this story is lucky to have been at one of the few Massachusetts hospitals to employ computer systems that help medical professionals avoid potentially fatal errors and adverse interactions between different drugs.

Massachusetts is home to some of the most advanced hospitals in the world with a long history of innovation that has enriched and saved countless lives. Yet 70 percent of the state's hospitals do not have the kind of computer systems that can dramatically improve patient safety while reducing healthcare costs. While powerful hand-held computers are used to track overnight packages and restock grocery store shelves, most physicians and nurses are still hand writing orders on charts.

Each year in the United States, 215,000 patients are harmed by medication errors that we could prevent. Nearly 7,000 people die unnecessarily. We know that computer systems can save lives and reduce the estimated $2 billion in costs created by medical errors.

The technical name for these systems is Computerized Physician Order Entry, or CPOE. When a doctor places an order for a drug, including how the drug should be administered and at what dosage, the computer systems provide added support for their decisions. These powerful systems don't tell doctors what to do. But at a time when thousands of new prescription drugs are helping improve people's lives, they offer critical information about how drugs interact to help avoid mistakes that could be fatal or cause longer, more costly hospital stays.

A recent report by the Massachusetts Technology Collaborative and the New England Healthcare Institute found that just 30 percent of the state's acute-care hospitals have these life-saving computer systems. High capital costs of the equipment, inadequate payment systems, and cultural resistance to change all threaten to keep these systems out of our hospitals.

A broad group of leaders is working for change, with the goal of implementing life-saving computer systems in all Massachusetts hospitals within four years. The price tag is approximately $210 million. However, conservative estimates from our report project net savings to the healthcare system in Massachusetts at $275 million annually. More important, we could save as many as 500 patient lives each year. With stakes this high, Massachusetts must overcome the barriers that stand in the way of implementing these new systems. This will require a ''high-tech transfusion" in all Massachusetts hospitals, one that cannot come about without focused leadership from the top.

Fortunately, powerful forces are moving this agenda forward. The governor, the Legislature, and key players in healthcare, led by Blue Cross Blue Shield of Massachusetts, the Massachusetts Hospital Association, and the Massachusetts Council of Community Hospitals, are working to bring these systems into all Massachusetts hospitals. In a parallel and closely related undertaking, the Massachusetts e-Health Collaborative has an even broader vision to adopt electronic medical records systems, with clinical decision support, in all Massachusetts healthcare settings in the next decade.

The promise of this high-tech vision is improved quality of care for patients and lower costs for us all. There is growing momentum for the prospect of making fundamental improvements in our healthcare system. We need to sustain the levels of commitment that have brought us to this point and harness all of our creativity to achieve the promise of these new technologies in improving the health of the Commonwealth.

Mitchell Adams is executive director of the Massachusetts
Technology Collaborative. Wendy Everett is president of the
New England Healthcare Institute.