E-Prescribing Threshold Too Low To Reduce Deaths: RAND

Higher requirements for Meaningful Use could decrease heart attack, heart failure, and pneumonia mortality, say researchers, but hospital executives remain skeptical.
Health IT Boosts Patient Care, Safety
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In Stage 1 of Meaningful Use, hospitals must show that their staffs used computerized physician order entry (CPOE) to order medications for at least 30% of patients. According to a new Health Affairs study, that threshold is "probably too low" to reduce the mortality rate of patients suffering from heart attacks, heart failure, or pneumonia by reducing medication errors and improving patient safety.

If the threshold were raised to 60% and then to 80% of patients--as the Centers for Medicare and Medicaid Services (CMS) expects will happen in stages 2 and 3 of Meaningful Use--the death rate could be cut significantly, the researchers said.

The co-authors of the study reached this conclusion by applying statistical modeling to American Hospital Association (AHA) data on electronic medication ordering and CMS data on the mortality rates of Medicare patients.

The results showed that, at the 30% threshold, CPOE could lower mortality by 1.2% for acute myocardial infarction or heart failure, a statistically insignificant amount. In contrast, they predicted that electronic medication ordering at the 60% threshold would lower the death rate for the two cardiac conditions by 2.1%, which the researchers did view as significant.

[Health IT is making it harder to keep protected health information secure and avoid federal fines. To learn more, read HIPAA Pain: How To Cope.]

An official of the American Hospital Association, which earlier this year warned a government advisory committee against moving too far and too fast on Meaningful Use, questioned the validity of the RAND study. "Identifying one aspect of the complicated information system in a hospital and saying this has an effect [on mortality] is a very challenging analysis to make," Chantal Worzala, the AHA's director of policy, told InformationWeek Healthcare. "That's why [the Health Affairs paper's] data on stage 1 of Meaningful Use has no statistical reliability. So many factors come into play that could not be modeled in this statistical exercise."

Worzala added that hospitals should not be rushed into implementing CPOE. "Hospitals are committed to using technology to improve care, and they understand that CPOE, when done right, is an important tool for improving the quality and safety of care. For us, the implementation of EHRs and other information technology is an evolutionary process. It's very important to get that done right. Putting in technology quickly to meet someone's expectations is less important than taking the time to put the technology in right to ensure that it is improving care and not having unintended consequences."

In the AHA's latest Most Wired Hospitals survey, 67% of the most wired hospitals said they were ordering medications electronically, compared with 46% of all hospitals. Other surveys indicate that less than 25% of hospitals have installed CPOE.

A HIMSS Analytics survey earlier this year showed that 12.3% of hospitals had reached HIMSS Analytics' stage 4, which includes physicians' use of CPOE on at least one inpatient unit. Two-thirds of the hospitals in the country remained in stages 1 to 3, and 10% hadn't even gotten that far.

All of which raises an interesting question: How many hospitals will be able to show they're ordering medications electronically for 60% of their patients by 2014, when stage 2 of Meaningful Use will probably begin?

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)

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