Revised Leapfrog survey frequires hospitals to test their computerized physician order entry

July 14, 2008

Hospitals will have to test their CPOE system to get a good rating from the Leapfrog Group.

Hospitals are going to have to work a little harder this year to receive a top rating from The Leapfrog Group. The patient safety advocacy organization revised the tools and questions it is using in its 2008 annual survey to measure the safety and quality of America's hospitals. This year's survey includes a Computerized Physician Order Entry (CPOE) evaluation tool that is designed to help hospitals determine how well the software program catches common prescribing errors. The evaluation tool was developed by First Consulting Group, a professional services firm based in Long Beach, Calif., and the Institute for Safe Medication Practices.

Leapfrog's 2008 Hospital Survey requires healthcare institutions with CPOE systems to test those systems in order to obtain the group's highest CPOE rating. Hospitals' CPOE test scores will not be publicly released this year, according to Leapfrog Group literature. However, the scores will be made public starting in 2009.

"The survey's test of hospital prescribing systems is one of its most important patient safety innovations," said Leah Binder, CEO of The Leapfrog Group. "Hospitals were amazed to discover that it revealed major gaps in their systems. Using the evaluation tool in the survey process will save lives."

Hospitals have responded to medication errors by introducing technological solutions such as installing a CPOE system. "It really does catch errors," said Mary Inguanti, R.Ph., M.P.H., and VP of operations at St. Francis Hospital Medical Center in Hartford, Conn. "Our CPOE (system) is tied to our (drug) dispensing cabinets. Our pharmacists have to verify every order for the cabinet to open."

St. Francis Hospital, which was named a Leapfrog Top Hospital in 2006, was one of the first in the country to fully implement a CPOE system. Inguanti said the 18-year-old system not only catches and prevents medication errors, it also helps the hospital benchmark outcomes.

"We can build screens for different types of initiatives," Inguanti explained. "We can call up specific reports or we can retrieve data from it. I think it really has helped enhance the safety of our patients."

Patient safety is a motivating factor behind the decision to include hospitals' CPOE systems in Leapfrog's survey. Since 2002, the survey has measured CPOE adoption among participating hospitals and has given higher ratings to those institutions that implemented CPOE systems. But this year's survey is the first to measure how effectively those systems work and how well they catch and prevent medication errors.

"It's good that the survey is tracking it," said James A. Jorgenson, R.Ph., M.S., FASHP, and former director of pharmacy services at the University of Utah Hospitals & Clinics in Salt Lake City. "Maybe if people know they are being measured on it, they will take some additional steps to implement it."

The Utah hospital, which has participated in past Leapfrog Group surveys, is about to implement a CPOE system in the next few months. Last year's poll revealed that only 10% of the 1,285 participating hospitals had fully implemented a CPOE system.

"The (CPOE) system is extremely complicated. I think a lot of work needs to be done before these systems can be implemented," said Jorgenson, who has since joined Clarian Health, Methodist Hospital, Indianapolis. "It's a big job."

Besides the CPOE evaluation tool, this year's survey includes a way for hospitals to measure how effectively they use resources for certain procedures and conditions. In addition, it asks for data on two hospital-acquired conditions, pressure ulcers and injuries during patients' stays. Hospitals will no longer be reimbursed by Medicare for these conditions beginning in October.

Individual survey results will be posted on the Leapfrog Group's Web site in July and results will be published in the fall.

THE AUTHOR is a writer based in New Jersey.