May 4, 2010
A study has found a correlation between the implementation of a computerized physician order entry system and improved patient outcomes, resulting in 36 fewer deaths over an 18-month period.
The study was conducted by researchers at the Lucile Packard Children's Hospital and Stanford University School of Medicine, and is seen as an exciting breakthrough since no published study to date has found an association with CPOE implementation and significant reductions in hospital mortality rates. That said, researchers were quick to note that the findings show a correlation, and not a cause and effect. According to lead author Dr. Christopher Longhurst, medical director of clinical informatics at Packard Children's and assistant clinical professor of pediatrics at Stanford, the implementation of CPOE occurred simultaneously with other hospital improvements including process and workflow changes, adjustments in ICU staffing, the rollout of rapid response teams, and the implementation of a nursing residency. "It is impossible to tell in a retrospective study how much of this effect can be attributed to the process and workflow changes introduced with CPOE," Longhurst said. "However, it is notable that looking over our last eight years of mortality data, the only two statistically significant inflection points are the rollout of rapid response teams and the introduction of CPOE," Longhurst added. To determine if a change in mortality rates occurred, researchers reviewed nearly 100,000 discharges from Packard Children's from Jan. 1, 2001, through April 30, 2009. They compared the observed mortality with the expected mortality, which was generated from a database of 42 tertiary care, not-for-profit pediatric hospitals similar to Packard Children's. According to the report, "After CPOE implementation, the mean monthly adjusted mortality rate decreased by 20%. With observed versus expected mortality-rate estimates, these data suggest that our CPOE implementation could have resulted in 36 fewer deaths over the 18-month post-implementation time frame." Prior to this report, research on CPOEs, which allow doctors to electronically prescribe orders, have largely focused on the efficiencies and cost savings that the system can bring to a hospital setting. Many observers note that technology, in and of itself, won’t make a positive impact on patient outcomes if these tools are not aligned with best practices in a hospital setting. "The key to achieving 'meaningful use' with EMRs is well-planned and well-executed projects which redesign processes and workflows in ways that leverage the technology," Longhurst said. "My advice to physicians and hospital administrators is to be involved and engaged early in the process to ensure that these systems are designed to meet the outcomes you need," Longhurst added.
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