CPOE Update

Leapfrog has released a CPOE test. This does not appear to be the tool that Leapfrog promised in 2001. The tool was supposed to be developed by FCG. There is no mention of FCG (or their new owner, CSC) in the press release.

In 2008 Leapfrog won’t be releasing the results. However, the hospitals will need to pass the test in order to claim that they have fully implemented the CPOE leap. I am predicting this will be delayed. But, I am a skeptic. Perhaps I should not be. There has been a lot of positive progress at the Leapfrog Group in the short time since Leah Binder took office in March 2008. We are finally moving the CPOE leap from an honor system. That is to be applauded.

It will be interesting to see the impact on the total number of hospitals making the leap. If the test is added to the 2009 CPOE leap requirement I suspect we will see a decline of hospitals meeting that standard.

In January 2006 I counted 63 hospitals claiming to have made the CPOE leap and another 58 claiming to be within 12 months of that goal. This month I count 144 hospitals claiming CPOE implementations that meet Leapfrog definition. I will let you decide if that is good progress or not. Anecdotally, the three in my area that said they were 12 months away at the start of 2006 are still not claiming the leap. One is still 12 months away and the other two are now claiming to be in the planning stages. I guess that is the nature of an honor reporting system that has no real incentives.

I wish Leapfrog were doing more to publish an analysis of their surveys. I had to add up 50 different separate queries to do this math. There are still a lot of questions. What percent of hospitals submit a survey? What percent of those are claiming full implementation of CPOE and other leaps? Which software vendors are supporting CPOE? When I have spare time I will do some more investigation.

My ePrescribing experience

One of the best moves I have ever made was selecting and installing the Purkinje ePrescribing product. Purkinje sells an EHR product too, but I really cannot speak to that.

Purkinje uses the Software as Service model, so there is no server hardware to manage. You just need to set-up a secure connection to their data center over the Internet. The software is web-based, so we did not have a special client to install.

We have been using their ePrescribing tool for nearly 5 years and our physicians really have embraced it. It is very simple and our incidence of downtime and unavailability have been well within our expectation. Purkinje had some great functionality that the bigger players did not have when we made the purchase. Most importantly, the system has a lot of clinical content that reminds our doctors about clinical research and costs specific to the illness they are treating. So, for example, if a doctor is treating a hypertensive patient for the first time the system will provide the doctor a quick, unobtrusive alert that reminds them diuretics are the preferred first line of therapy in most patients and a fraction of the cost of most alternatives.

Purkinje Screen Shot (fit)

We were able to get rid of the prescription pads quickly.  I have heard many anecdotes about the system catching medication and allergy conflicts that might have otherwise been missed.

Through interfaces to our MEDITECH Magic HIS the doctor’s are able to select patients from their schedule that appears in the ePrescribing system. Each time the medication list is updated we send a report in MEDITECH so our patient’s medication list is available in MEDITECH’s PCI.

This is why I support Medicare’s push for electronic prescribing. Unlike the Leapfrog group’s poorly considered call for CPOE, ePrescribing is easily accomplished, commercially available and proven to truly be be beneficial to the health, safety and pocketbook of patients.

Leapfrog is irrelevant

It’s official (because I am writing it here). The Leapfrog Group is no longer relevant. Perhaps they never were. We can stop talking about them now.

I just finished reading through their 2006 press releases. Almost all of those press releases are the Leapfrog Group commenting on other organization’s quality initiatives.

The only accomplishment that the Leapfrog Group claims is receiving more surveys than ever before. Like usual, there is no comment on the pace at which the submitters of those surveys are embracing the leaps. It seems like they could have counted up those surveys by now (they were due on June 30). I suspect they know the numbers, but there isn’t anything to brag about.

Where are the corporate sponsors? I thought they were big into accountability?

I believe the Leapfrog Group made a mistake in choosing CPOE as their first leap. There are so many other safety initiatives that produce excellent safety results and are significantly more achievable.

The fact is that the number of hospitals that have implemented CPOE is insignificant. Last year that number was less than 80 (out of nearly 1,000 surveys received). That is pretty dismal for the 4th year. I don’t expect a great increase this year. Ironically, one of my hospitals will be one of the few additions.

And, what has ever happened to the Leapfrog Group/FCG tool to test the clinical alerts in a CPOE system? This was announced in 2001? Is it out there and I just missed it? Or, is the Leapfrog Group 4 years behind schedule?

It really doesn’t matter. Because there are far more important patient safety initiatives (IHI’s 100K lives). And, because nobody is listening. CPOE mania is dying as executives realize that they have better patient safety opportunities that are more proven and don’t disrupt their admitters.

Since Leapfrog launched 5 years ago they have never steered a single patient to a hospital with CPOE (I could only hope). I would bet they never will.