Leapfrog, a consortium of employers and public and private healthcare purchasers, bases its annual ranking on a survey of hospitals' processes, quality of care, and patient safety. Its evaluation includes "stringent IT requirements," said Leah Binder, Leapfrog CEO in an interview with InformationWeek Healthcare.
Approximately 1,200 hospitals--or about one quarter of U.S. hospitals-- participated in the 2011 Leapfrog survey. Sixty-five facilities earned Leapfrog's Top Hospital designation.
Leapfrog's survey focuses on three critical areas of hospital care: how patients fare; resources used to care for patients; and management practices that promote safety and quality. In each of the three areas, Leapfrog asks hospitals to report on nationally standardized measures so consumers can compare hospitals in their community and nationwide.
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IT plays a key role in several of the quality measures looked at by Leapfrog, especially where they relate to prevention of medication errors that can lead to longer hospitals stays, readmissions, and even deaths.
A key requisite to be considered a top hospital is having 75% of inpatient medication orders--not including the emergency department--entered through a computerized physician order entry (CPOE) system.
All hospitals in the running for top hospital status by Leapfrog also "must pass the CPOE test," once they complete their survey, said Binder. The Leapfrog CPOE evaluation includes a series of simulated orders for make-believe patients, and simulated "problem orders," which the hospitals run through their CPOE, said Binder.
The hospital's CPOE must catch the problem orders and alert doctors to at least half of the most common and potentially most serious prescribing mistakes. Those errors might range from incorrect dosing to drug-to-drug adverse interactions.
Among Leapfrog's top hospitals in 2011 was Lehigh Valley Hospital, which also made the list in 2007. Lehigh has been using CPOE for eight years in what was "the first steps to cut potential adverse events," said Lehigh Valley Health Network CIO Harry Lukens. "What they say about doctors' handwriting [being illegible] is true," he said.
Lehigh Valley Hospital currently processes 97% of its orders electronically using CPOE, which is complemented at the facility by a bedside barcode medication safety system that LVHN rolled out six years ago. The barcode system helps nurses confirm that correct medicines are being administered in the right doses at the right time to the right patient.
Initially, LVHN's CPOE and barcode systems were not warmly embraced by clinicians because they changed work habits, said Lukens. Prior to installing the CPOE, doctors often would rely on nurses to place drug orders. With CPOE, physicians make orders. Also, the medication bar coding system requires nurses to take the extra steps of scanning medication and patient ID barcodes, which was something that also took some time getting used to, said Lukens.
As first, "these systems weren't greatly accepted. It was one more thing [for clinicians] to do," said Lukens. Doctors and nurses weren't sold on the technologies until the systems "caught a wrong medication or dose" before they were administered to patients, he said.
When it comes to the bigger picture, the use of CPOE is "growing slowly" at U.S. hospitals, said Leapfrog's Binder. Even with the promise of billions of dollars in incentives from the HITECH Act's programs for the meaningful use of health IT, "we're still not yet seeing a level of adoption or advancement of CPOE" that makes effective use of the technology the rule rather than the exception, said Binder. However, that could change in coming years.
Leapfrog hasn't added use of electronic health records (EHRs) to its quality criteria yet. It has found that "for some hospitals, CPOE is sometimes easier," than EHRs to implement first, said Binder. "CPOE is an earlier win" to get physicians and other clinicians seeing how technology can improve quality of care and boost patient safety, she said.
"Medication errors are the number-one error that happens in hospitals," Binder said. "CPOE is directly effective in helping to reduce that," she said. However, it's important for hospitals that have implemented CPOE to test and monitor the systems regularly.
It's also important that hospitals don't abandon other best practices, such as having nurses check records or ask patients about allergies. "Hospitals are naive to rely too much on CPOE. It's also important not to cut other steps to ensure safety," said Binder.
"Nurses won't want to rely on computers" totally, she said. In fact, many of the potential mistakes that aren't picked up by CPOEs are often caught by clinicians before medications are dispensed to patients, she said.