Electronic medical orders may save lives: study

Doctors at a California children’s hospital have found the first evidence that using an electronic system to communicate their orders may save lives.

After the system was introduced in 2007, the hospital witnessed a 20-percent drop in mortality rate, the equivalent of 36 fewer deaths over a year and a half.

“It’s the lowest rate ever observed in a children’s hospital,” said Dr. Chris Longhurst, of Stanford University and Lucile Packard Children’s Hospital in Palo Alto, California, whose findings are published in the journal Pediatrics. “It begs the question how many lives could be rescued on a national level.”

In 1999, a report from the Institute of Medicine blamed medical errors for between 44,000 and 98,000 deaths per year in the United States. Many hospitals have since introduced so-called computerized physician order entry, or CPOE, in an effort to lower that number.

Such systems allow doctors to relay prescriptions to pharmacists without delay, and without the need for the pharmacist to decipher doctors’ scrawl.

“What used to take 40 minutes or so now takes 20,” Longhurst told Reuters Health.

Although close to three in ten U.S. hospitals use CPOE, no one had been able to show a decrease in mortality until now. In 2005, a Pittsburgh hospital even reported an increase in the number of child deaths after it implemented the system.

“There have been a couple of studies previously that have taken a similar approach and have found the opposite result” of the current study, said Nir Menachemi, an expert in health information technology and policy at the University of Alabama at Birmingham. “I was more surprised by those studies.”

The debate over whether CPOE is working as intended is hardly over, said Menachemi: “I think it would be foolish to believe that any one study can end the discussion.”

According to Longhurst, what set Packard Children’s Hospital apart was its careful and well-planned implementation of CPOE.

He said the hospital, which has a total budget of between $600 and $700 million, had spent about $50 million on the project.

“We have realized some cost savings, but I could not tell you that we’ve saved money,” he said.

However, the hospital has saved lives, it appears. When analyzing about eight years’ worth of data, the researchers found that average mortality dropped from slightly more than one death per 100 hospital discharges to around 0.7 with the introduction of CPOE.

The system has also helped doctors limit some unnecessary procedures such as blood transfusions, which Packard Children’s Hospital had overused, according to Longhurst.

While it’s hard to prove that CPOE is directly responsible for the decrease in mortality—which could have been brought about by other improvements during the same period—the researchers did the best they could to account for those factors.

“The cards were almost stacked against finding positive results,” said Menachemi, noting that the hospital had admitted more severely ill children after the new system was taken into use.

Despite the encouraging findings, Longhurst said he was concerned about President Obama’s call for rapid implementation of the electronic system.

“It should be rolled out by experienced experts,” he said. “And there are only so many experts in this country.”

SOURCE: Pediatrics, online May 3, 2010.