Hospitals’ drug-ordering systems show flaws, some potentially fatal

Computerized_physician_order_entryThe United States has spent billions of dollars to try to slash medical errors, the third highest cause of death in the nation. But computerized systems that allow physicians to enter their drug orders−a key tool in the fight against one of the most common cause of medical errors−aren’t yet stopping as many problem prescriptions as they need to, says a nonprofit organization that rates hospitals’ safety.

The Leapfrog Group, with the help of outside information technology experts, surveyed 1,800 hospitals nationwide, asking them about their systems, and testing them with dummy orders for fictional patients to see if they caught errors.

The good news: 96 percent of the hospitals said they now have digitized prescription ordering systems in place, and working to some degree.

The bad news: those systems failed to flag 39 percent of potentially harmful orders submitted on them. Further, the systems didn’t ring alarm bells they needed to in the 13 percent of cases with potentially fatal errors.

Leapfrog called on hospitals to double- and triple-check that systems and processes to improve the accuracy of medication orders, and to fully take advantage of the safety and cost innovations that computerized systems should provide.

The organization’s surveys, it should be noted, have proven controversial. Hospitals participate voluntarily in them, and many have questioned the nonprofit’s research methodologies and contested its results, particularly when they are adverse.

The computerized ordering systems, which previous research has shown have helped hospitals make major strides in reducing erroneous drug orders, also have drawn critics’ fire. They say that the systems require the inputting of accurate information, but this isn’t always provided; doctors can cut and paste digitized, wrong information from one electronic health record to another, introducing error. The systems also are susceptible to fraudulent data entry. Many hospitals also haven’t gotten the systems fully up to speed yet.

I’ve written recently about New York’s efforts to require physicians to abandon handwritten scribbles on paper pads in favor of electronic prescription systems. These allow better tracking of medications, including to avert criminality and to ensure that doctors are following best practices and accepted standards of care in their prescribing.

The health care industry, like every sector of the U.S. economy, has struggled to keep up with technological advances, with computerized order systems and electronic health records expensive and extensive examples. Throw in hospitals’ new combat with cyber hackers and ransomware assaults and the institutions have their hands full. But the latest results on the computerized entry systems offer a sober reminder that hospital IT can be a critical matter of life, death, and patient safety.

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