Another CPOE Rant

If CPOE was such a promising technology to improve patient safety, why has the Leaprog Group failed to deliver its CPOE evaluation tool? In November of 2001 Leapfrog promised to collaborate with FCG to deliver an evaluation tool in 2002.

The first version of the CPOE evaluation tool may still be coming. In mid-2005 Leapfrog promised that the tool would accompany the next survey. I believe that is due in April 2006. This is over THREE years after it was initially promised. Even my worst projects are not delivered this far off schedule.

Why does Leapfrog expect 100-bed community hospitals to implement technologies that it can’t seem to master, even with all of the financial backing of its members / funders and the intellectual capital of the country’s largest healthcare IT consulting group (FCG)?

Was Leapfrog premature in suggesting that CPOE was an immediate opportunity to improve patient safety? Sure CPOE is great in theory, but then again, so are flying cars.

I do appreciate that Leapfrog has provided a definition of true CPOE, which they say includes three elements:

  1. Assure that physicians enter at least 75% of inpatient medication orders via a computer system that includes prescribing-error prevention software;
  2. Demonstrate that their inpatient CPOE system can alert physicians of at least 50% of common, serious prescribing errors, using a testing protocol now under development by First Consulting Group and the Institute for Safe Medication Practices [this is the missing evaluation tool]; and,
  3. Require that physicians electronically document a reason for overriding an interception prior to doing so.

Despite this clear definition health systems continue to claim that all kinds of things are CPOE, like clinic e-prescribing systems. Ambulatory CPOE is an oxymoron.

Most CPOE implementations that I see don’t even try to tackle 2 and 3. For that matter they can’t meet the threshold of the first criterion. What is the value in that?

And even though the Leapfrog survey instructions are clear there are many instances where hospitals submit CPOE claims that are, at best, overly ambitious. It will be interesting to see how many hospitals report true CPOE success in their 2005 survey after reporting that they were a year away from full CPOE in the 2004 survey.

Update: a few hours after posting this I was heading to the bathroom (I know, TMI) and I grabbed whatever was on top of my mail pile. That turned out to be the HIMSS 2006 materials. As I was flipping through it I saw that FCG and University of Pennsylvania Health System will present the benefits of the CPOE Evaluation Tool (Education Session Number: 58). Perhaps Penn is the beta site.

It appears, by the title of the seminar, that the intent is for the tool to be available before HIMSS. So, Leapfrog and FCG may be making some headway. Then again, since the HIMSS submission deadline is in May this may have been wishful thinking.

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