HEALTH-SYSTEM EDITION
BUSINESS/MANAGEMENT

Shrewd cost-benefit analysis key to shopping for technology

With today's emphasis on patient safety and reduction of medical errors, pharmacists and hospital administrators are quickly realizing they are the next big market. Purveyors of gear ranging from computerized physician order entry (CPOE) systems to prescription-filling (and supposedly error-proof) robots now target pharmacists with a deluge of product advertising. With the marketing comes the promise of mistake-free order fills, freedom from doctors' illegible scribble, and peace of mind for providers and patients.

But do those systems work in the real world the way they do in a promotional brochure? Are they really worth the millions of dollars in purchase and startup costs?

Only a data-driven cost-benefit analysis using dollars-and-cents logic can truly minimize the guesswork and guide a good purchase, according to Peter K. Wong, Ph.D., R.Ph., v.p. for clinical effectiveness and performance improvement at Good Samaritan Hospital, Dayton, Ohio. And that may mean cutting through some hype, he told an audience at a recent conference on patient safety designs sponsored by the VHA Health Foundation.

While detailers are quick to point out the virtues of their products, they may not have much insight into how well the systems work with humans. "They are selling you an ideal situation," he said. "When you invest, make sure you focus on your objective. Don't let all this promotional material influence your decisions."

Wong has some experience with exciting products that fell short in practice. A few years ago, his hospital bought a robotic Rx-filling machine as a down payment on cutting Rx errors. The machine worked well until a human technician filled one of the hoppers with the wrong tablets. The error exemplified what many R.Ph.s forget about new technology, Wong said: It can amplify mistakes as easily as it can reduce them. "Now I have 1,000 errors I have to chase down."

That's not to say that such a system is not worth the money. About 60% of all adverse drug events in one VHA study could be traced to medication-ordering problems, while another 14% were attributed to errors in dispensing and distributing medications.

Another study in 1997 found that one in six adverse drug events was caused by insufficient knowledge about dosing, and one in 10 is related to use of incorrect drug names and questionable abbreviations. So investments in cutting prescription errors could improve productivity, reduce the likelihood of expensive lawsuits, and improve patients' care.

Wong just wants decision- makers to be aware of all the costs involved, even those that are indirect and not obvious at the time of purchase, he said. In addition to buying a system, consider the long-term costs of implementation, staff retraining, and even the cost of dissension among staff when their practice patterns drastically change.

Everyone was looking at a new CPOE system to be an instant "savior" for widespread legibility problems at Samaritan Family Care in Englewood, Ohio, according to Jeffrey W. Petry, one of the group's administrators. In reality, doctors and many nurses rejected the system, requiring a massive retraining effort. "The reality is that implementation is three years away, probably four. It's creating a lot of strife down in the pharmacy department," Petry said.

Since time is money, any potential for extended implementation must be factored into a cost analysis, as must a realization that time spent battling a new computer is time lost seeing a patient or filling an order the old way. Also essential is the opportunity cost, or price of not being able to use the money you invest for some other purpose.

According to Wong, most hospitals can expect to pay double or triple the $10 million or so it takes to buy a CPOE system just for a hospital to get the system fully operational.

Once the decision to invest is made, a careful before-and-after analysis is the only way to track real costs and benefits and to objectively guide future purchases. The key is to practice consistency in what you measure before your purchase and after implementation.

Of course, the ultimate goal is to get the maximum benefit for patients and the lowest possible cost. "That is the biggest bang for your buck for medication safety," Wong concluded.

Todd Zwillich

Todd Zwillich. Shrewd cost-benefit analysis key to shopping for technology.

Drug Topics

2002;22:HSE47.