Computerized Provider Order Entry Results in Savings to Society and Health Improvement in Acute Care Hospitals
Article Featured in August 2015 Issue of The Joint Commission Journal on Quality and Patient Safety
(Oak Brook, Ill., July 28, 2015) Joint Commission Resources, Inc. today released the August 2015 issue of The Joint Commission Journal on Quality and Patient Safety, featuring the article, “Implementing Computerized Provider Order Entry in Acute Care Hospitals in the United States Could Generate Substantial Savings to Society,” by Teryl K. Nuckols, MD, MSHS, and colleagues. The article reports the findings of a study conducted to evaluate the cost-utility of implementing computerized provider order entry (CPOE).
Using a decision-analytical model, the authors compared CPOE with paper ordering among patients admitted to 3,912 acute care hospitals in the United States with more than 25 beds. Parameters included start-up and maintenance costs, as well as costs for provider time, medication and laboratory test ordering, and preventable adverse drug events. Probabilistic analyses produced incremental costs, effectiveness, and cost-effectiveness ratios for hospitals in four bed-size categories. Results showed that CPOE had, on average, more than a 99 percent probability in yielding savings to society and improving health.
The authors anticipate that increases in CPOE implementation nationwide from 2009 through 2015 could save approximately $133 billion and 201,000 quality-adjusted life-years. Even small hospitals, which lack economies of scale, have a greater than 70 percent probability of savings, unless implementation costs are more than twice as high as reported.
In an accompanying editorial, “The Value of Computerized Provider Order Entry: Is It Time for the Debate to Be Over?,” Emily Beth Devine, PhD, PharmD, MBA, University of Washington, Seattle, states that the Nuckols et al. article “represents the most comprehensive estimate conducted to date of the societal value of the nationally recommended strategy of widespread adoption of CPOE/CDS [clinical decision support] systems in the inpatient setting.”
The remaining articles from the August 2015 issue are as follows:
Advancing Medication Safety: Establishing a National Action Plan for Adverse Drug Event Prevention
Yael Harris, PhD, MHS; Dale J. Hu, MD, MPH; Christine Lee, PhD, PharmD; Mishale Mistry, PharmD, MPH; Andrew York, PharmD; Tisha K. Johnson, MD, MPH
In 2014, the Office of Disease Prevention and Health Promotion released the final version of the congressionally mandated National Action Plan for Adverse Drug Event Prevention. For each of three medication classes—anticoagulants, diabetes agents (insulin and oral hypoglycemic agents), and opioids— the plan addresses surveillance; evidence-based prevention; payment, policy incentives, and oversight; and research opportunities to advance medication safety.
Facilitation of a Multihospital Community of Practice to Increase Enrollment in the Hospital to Home National Quality Improvement Initiative
Paul A. Heidenreich, MD, MS; Anju Sahay, PhD; Brian S. Mittman, PhD; Nancy Oliva, RN, PhD, MHA; Parisa Gholami, MPH; John S. Rumsfeld, MD, PhD; Barry M. Massie, MD
Hospital to Home (H2H) is a quality improvement initiative for the transition of care for inpatients with heart disease. The impact of a heart failure (HF) provider-based community of practice (COP) was studied within the Department of Veterans Affairs health care system. Of the 61 hospitals randomized to HF COP facilitation, 33 (54 percent) enrolled in H2H, compared with 6 (10 percent) of 61 control hospitals (p < .001) at five months after randomization. Facilitation using the HF COP also provided implementation support for recommended quality improvement projects.
Accuracy of the Adverse Outcome Index: An Obstetrical Quality Measure
Lisa M. Foglia, MD; Peter E. Nielsen, MD; Eileen A. Hemann, EdD; Suzan Walker, MPH; Jason A. Pates, MD; Peter G.Napolitano, MD; Shad Deering, MD
In obstetrics, a nationally accepted set of quality indicators for patient safety was not available in the United States until the development of a set of 10 adverse outcome measures—the Adverse Outcome Index (AOI). Among 4,000 randomly selected charts, 29 deliveries had at least one adverse outcome, reflecting an AOI of 5.7 percent. The AOI, highly reliant on accurate coding and provider documentation, should be modified to better measure preventable adverse events and account for preexisting conditions.
Connecting Patients and Clinicians: The Anticipated Effects of Open Notes on Patient Safety and Quality of Care
Sigall K. Bell, MD; Patricia H. Folcarelli, RN, PhD; Melissa K. Anselmo, MPH; Bradley H. Crotty, MD, MPH; Lydia A. Flier; Jan Walker, RN, MBA
Experience with notes open to patient review suggests responses to three emergent overarching questions: (1) How do patients and providers view the potential effects of open notes on patient safety and quality of care? (2) How do physicians anticipate reacting to mistakes patients find in the notes? and (3) What are the potential implications of shared visit notes for institutional disclosure, education and patient engagement?