Free Hospital EMR and EHR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to Hospital EMR and EHR for FREE!

Half of Medication Errors Found In PA Study Involve HIT Issues

Posted on March 29, 2017 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new study by a Pennsylvania healthcare organization has found that computerized order entry systems and pharmacy systems were the most commonly reported factors contributing to medication errors in the state.

The Pennsylvania Patient Safety Authority, an independent agency tasked with finding and reducing the rate of medical errors in the state, recently released a report on medication errors reported to the agency during the first six months of last year. Under state law, Pennsylvania-based providers cutting across several categories, including hospitals, ambulatory surgical facilities and birthing centers, are required to disclose adverse events and “near misses” to the agency.

Between January 1 and June 30, 2016, the state’s healthcare facilities reported 889 medication-error events which cited health IT as a factor in the event(s). The errors most often reported were dose omission, wrong dose or overdosage and extra dosages, while CPOE and pharmacy systems-related problems were the most commonly reported health IT issues. (High-alert medications such as opioids, insulin and anticoagulants – which pose a higher risk of harm if misused – occupied three of the top five drug categories involved in most events.)

When they analyzed the data, agency analysts found that health IT-related errors took place during every step of the medication use process, and worse, most of those errors affected the patient directly, the data suggested.  And things may get worse before they improve. To hear agency officials tell it, HIT-related medication problems have become more common as health IT infrastructures have matured.

“As more healthcare organizations adopted EHRs and such systems became increasingly interoperable, the Authority observed an increase in reports of HIT-related events, particularly in relationship to medication errors,” said agency executive director Regina Hoffman in a prepared statement.

The Authority’s data doesn’t gibe completely with other research. For example, a report by the Leapfrog Group and Castlight Health notes that CPOE use has been very effective at reducing medication error rates. The report specifically refers to a CPOE study led by David Bates, MD, chief of general medicine at Brigham & Women’s Hospital, in which rates of serious medication errors fell by 88 percent during the period studied. Elsewhere, Leapfrog has cited studies in which CPOE use seems to have cut hospital lengths of stay, as well as major reductions in pharmacy, radiology and lab turnaround times.

On the other hand, the same report notes that CPOE systems still have a long way to go before they realize their potential. According to the 2015 Leapfrog Hospital Survey, hospitals’ CPOE systems failed to flag 39 percent of all potentially harmful drug orders, as well as 13 percent of potentially fatal orders. So it’s not a huge stretch to imagine that CPOE-using Pennsylvania hospitals are still having medication errors fall through the cracks.

It’s also worth pointing out that doctors don’t necessarily see CPOE systems as their best friend either. A study published last year in the Mayo Clinic Proceedings found that physicians who use EMRs and CPOE had lower satisfaction with time spent on clerical tasks and higher rates of burnout. Of course, given that the study lumps CPOE use in with EMR use, the results are somewhat skewed, but it’s still a data point worth considering.

CPOE Alerts Still Vex Doctors

Posted on April 20, 2016 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

A new study by Castlight Health has found that while nearly all hospitals have implemented CPOE systems, those systems are far from perfect. And that may be because too many clinicians find system alerts to be a distracting annoyance.

The research, based on an analysis of data collected by The Leapfrog Group, found that 96% of hospitals reported use of a CPOE system, up from 33% in 2010 in a scant 2% in 2001.  This data is drawn from the 2015 Leapfrog Hospital Survey of 1,750 U.S. hospitals.

But while the high adoption rate might be good news, it comes with bad news as well. The Castlight analysis found that even where hospitals had CPOE systems in place, 39% of possibly harmful drug orders and 13% of potentially fatal orders weren’t flagged by the system in place.

The most common errors that didn’t get flagged included when clinicians prescribed the wrong meds for the patient’s condition, or the wrong dose or meds entirely inappropriate for kidney function, and the failure to display a reminder to test drug levels after issuing medication.

These errors are occurring despite the fact that many of the hospitals studied by Leapfrog (64%) met its CPOE standard. To do so, the hospitals had to alert physicians about a minimum of 50% of common, serious prescribing errors. Also, physicians had to order at least 75% of inpatient medication orders through a CPOE system.

So if the CPOE system is being used actively, and performing as it should in most cases, why would nearly 40 percent of potentially harmful drug errors slip by? The answer may be that fairly or not, CPOE alerting is still seen as a hindrance rather than a help by many physicians.

While I don’t have hard statistical evidence to this effect, the anecdotes doctors share suggest that some click through alerts as quickly as possible. One physician blogger shared that he was quite frustrated by the alert generated when he wanted to prescribe 81mg baby aspirin tablets, which patients can buy over the counter. I understand his frustration (and even what seems like wounded pride).  And if it took several clicks to dismiss the related prompts, I’m sure it was indeed annoying.

On the other hand, as my colleague John Lynn rightfully notes, doctors aren’t going to blog or tweet about the time the CPOE system alert saved them from making a major prescribing error. So there is a bias to comments and blog postings since they only cover the negative side of CPOE and not the positive side. Perhaps the doctors who are working with these alerts successfully are simply going about their business and feel no need to vent. (Please note: I’m not suggesting that those who do vent are out of line in some way.)

Still, it seems quite clear that there’s considerable work to do in improving the workflow around physician alerting. If hospitals with CPOE in place are still seeing this level of potentially harmful or fatal prescribing, after many years to adapt to alerts, they need to do more to accommodate physicians.

P.S. They might want to start with a look at how Montefiore Medical Center succeeded with its CPOE rollout.

Digital Health Tech Funding Keeps Growing

Posted on September 25, 2015 I Written By

Anne Zieger is veteran healthcare editor and analyst with 25 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. She can be reached at @ziegerhealth or www.ziegerhealthcare.com.

I recently had a chance to look at data from CB Insights on digital health funding, and it turned out to be worth seeing. While anyone in healthcare IT knows that digital health technologies are a Big Deal, I hadn’t pieced together just how much money is pouring into the space.

According to CB Insights, digital health funding hit a robust $3.5B last year, and the space saw several IPOs as well.  A full 30 digital health ventures cashed out in 2014, compared with just eight exits by US-based digital health players in 2011.

One interesting feature of this activity is that three of the four companies that went to IPO last year (Care.com, Everyday Health and Castlight Health) support consumers. Honestly, I would have assumed that companies that serve providers would have had a bigger footprint.

Also, while there’s too few too data points to draw broad conclusions, I note that the two biggest deals done in 2014 — the Fitbit IPO and Under Armour’s $475M buyout of MyFitness Pal — were done by companies with a consumer focus as well. And Fitbit stock has gone great guns, with its value soaring from $4.1B at IPO to a market cap of about $8B.

On the other hand, it’s worth noting that the biggest exit listed by CB Insights was that of Veeva Systems, which provides cloud-based services to the life sciences industry. Clearly, there’s still a meaningful place for digital health companies that serve B2B needs.

On top of all of this investment, it’s worth noting that some of the hottest action in digital health isn’t going to make the CB Insights funding list. After all, well-funded giants like Apple, Qualcomm, Microsoft, Google and Samsung are just hitting their stride when it comes to digital health solutions. These behemoths bring their own huge piles of cash to the party, and pump up the opportunities in this space just by being there.

While healthcare probably isn’t mission-critical to any of the companies above, there’s still signs that they intend to invest heavily in digital health — and may yet prove to dominate key verticals. (For example, Apple HealthKit has tremendous potential, and its approach could become the default for integrating consumer health data with EMRs.)

Bottom line, the digital health market is very much in flux, and very hard to call. If I were sitting on a pile of cash, I’d probably invest in personal digital health data integration with providers, but that’s just me. The record so far suggests that investors haven’t given the provider enablement side of digital health, but rather, consumer empowerment.

I do think that the market will eventually swing around to hard-core business services that integrate all of these consumer digital health investments with day-to-day care. But it could take a few years of investors chasing rainbows until they get practical. In the mean time, hospitals would be smart to make their own digital health plays and even do their own startups. While digital health companies are everywhere, providers need to have a say in how this niche plays out.