October 29, 2001

When the Institute of Medicine released its 1999 report "To Err is Human," stating that errors cause between 44,000 and 98,000 deaths every year in American hospitals, the medical establishment was shaken.

Anguished discussion ensued about what to do. Everyone agreed something had to be done.

The Health Center responded by embarking on an initiative that uses computer technology to address the concerns of the report. The Electronic Order Entry Pilot program was launched in September.

"Tens of thousands of medication errors occur each year in the U.S. And it's been estimated that 50 percent of them can be reduced by enforcing computer rigor on how a drug is ordered," says Richard Simon, a professor of surgery and co-chair of the committee overseeing the program. "We can't leave patients at risk while we can take a few simple steps to eliminate these errors in the meantime."

In providing medication for a patient, three main opportunities for mis-medication may occur: while prescribing, the physician could write the wrong dose or the wrong medication; a mistake could take place in transcribing the order; and mistakes may be made when the medication is administered to the patient.

A computer can be programmed to make sure none of these situations occur - "electronic reconciliation," Dr. Simon calls it. "At the point of administration of a drug, electronic reconciliation will ascertain that the drug is appropriate," he says.

How it works is that each medical order has a computer label, such as a barcode. So does the patient. So does the person administerin g the medication. If the information entered on the order doesn't square with the patient, the medication, the dose, or the person administering it, the computer calls the error to everyone's attention.

The culture change involved is the precision and time necessary to enter all the information on the order.

"Doctors do not easily conform to the rigors of computer entry," says Simon. "If they can't log on and write as fast as they can by hand, their acceptance of the program is going to be compromised. It is absolutely vital that the computer entry is friendly to the doctor or the person doing the ordering," he says.

"We've had some resistance on the part of the doctors," says Lynn Anderson, assistant nurse manager of the Post-Anesthesia Care Unit, one of the two units to which the system has been introduced. "We need to change doctors' perception of the system as an additional burden, to seeing it as an advance in patient safety."

In addition to patient safety, a computerized ordering procedure has powerful financial ramifications.

Hospitals constantly lament the size and amount of their reimbursements from insurance coverage and the government. Part of the reason the reimbursements do not reflect the services provided is that frequently the documentation or the request is either vague or incomplete.

Busy doctors and nurses may not take the time to fill out a record in detail, and the intention to catch up on paperwork later may never be realized because the work doesn't stop. Yet inadequate documentation jeopardizes payment.

Computer tracking can provide a precise record of what service was provided - an X-ray or a blood test, for example - or what medication was administered and when.

In addition to the Post-Anesthesia Care Unit, the program has been rolled out on the Dempsey Hospital's seventh, post-operative, floor. MedSurg5, and Fourth Floor, Medicine, are scheduled to begin using it next.

Information technology plays a key role in the initiative. "The use of information technology in the clinical environment is a relatively new endeavor for the clinician, and may take some getting used to," says Linda Shanley, director of Clinical Enterprise Systems and committee co-chair.

"But putting information at the fingertips of the doctors at the point they're making decisions is an efficient use of technology and is going to be more widespread in the future."

Physician order systems are available commercially, but the system currently being installed was developed by and for the Health Center.

"When the time comes to get a commercial system," says Simon, "we'll be fully experienced and comfortable with it. It will be a struggle already won."

Pat Keefe