Taking a Leap Toward Improved SafetyAfter the 1999 Institute of Medicine report citing over 7,000 deaths annually from medical errors, computerized provider order entry has been advocated as a means to reduce such errors. This cause has recently been taken up by regulatory agencies, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), as well as independent consumer groups. The most prominent of such groups is the Leapfrog Group, which represents the healthcare concerns of the 33 million Americans employed by Leapfrog’s 130 member organizations. The Leapfrog Group made patient safety its top priority after its own report documented more than 1 million serious medication errors occurring in US hospitals every year. Computerizing the process of ordering tests and medications is seen as the best way to reduce errors, since the number of steps and people involved in carrying out an order are minimized. Although development of an online order management system is highly recommended, a recent national survey by Hospitals and Health Networks shows that Deborah is among less than 25 percent of hospitals in the country that have developed a computer system that allows providers to directly order medications and laboratory tests. “Deborah’s provider order management system is an integrated part of Meditech and represents over three years of development and testing by an interdisciplinary team of physicians, nurses, technicians, administrators and pharmacists,” says Frank Lumia, MD, Assistant Chair of Cardiology and Co-Director, Section of Nuclear Medicine, one of the leaders of the effort. |
Over the past two years, several versions of the system have been tested and the most recent version appears to have incorporated many of the suggestions the Deborah team made to Meditech to help streamline the order entry process. According to Sumathisena, MD, Attending Cardiologist, who leads the Cardiology service that piloted, and is currently using, the newest version, “There is certainly a learning curve, but once you have it, the rest is easy.” In fact, part of that learning has been changing old patient care processes that used to have built-in delays. Now, when a doctor orders a meal for a patient, the information is delivered immediately to the Food/Nutritional Services Department and a tray is sent, sometimes so fast that the doctor may not be able to change his mind 15 minutes later when he orders a test that requires the patient not eat. “We have to work with it and get used to living with it,” says Dr. Sumathisena. “It is the future.” After testing and tweaking on Dr. Sumathisena’s service, the provider order management system will be ready for hospital-wide use. |
Computer systems with the ability to deliver accurate patient information at the point of care and cross reference orders with the patient’s other medications, allergies and health conditions are also critically important in the effort to improve patient safety. According to Dr. Lumia, “Deborah’s system is unique because it is a fully integrated system. After entry, the orders are sent immediately to the appropriate department. In many less-integrated systems, orders print out in the pharmacy, and then must be re-entered into the pharmacy’s system. With Meditech, the information is entered once, and is sent everywhere it’s needed, without re-entry.” Also being currently implemented is a state-of-the-art radiology PAC system, which stands for Picture, Archiving and Collection System. When an x-ray or CAT scan is completed, this system allows the Radiology Department to pass the images digitally onto the network, making them available to doctors on workstations throughout the hospital. Coupled with provider order management, the PAC system will greatly reduce the time needed to generate images, review them and act on the results. With all of its recent technology innovations, Deborah has joined the ranks of the most wired healthcare centers in the country. According to Gerard Williams, Director of Information Systems, “Deborah has made much more of an investment in Information Systems over the past few years than it had 10 or 15 years ago. I think people are seeing the advantages of it, and, in order to stay competitive, we have to use it to the fullest, for all aspects that it helps, from billing to faster, improved patient care.” |
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