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What’s New in the
Patient Safety World
June 2020
EMR and Medication
Safety: Better But Not Yet There
We’ve always liked the Leapfrog CPOE EHR
evaluation tool. It’s one of the few objective
measures of patient safety performance of various healthcare IT systems. See
our prior columns, listed below, on this tool.
The most recent analysis (Classen 2020) of results from the Leapfrog CPOE EHR evaluation tool shows some improvement over time but highlights the persistence of vulnerabilities and the wide variability of hospital CPOE EHR systems to identify medication errors and prevent adverse drug events (ADE’s).
The tool uses
simulations of scenarios drawn from incidents of preventable ADE’s that
occurred in real patients who experienced injuries or death. It tests both
basic and more advanced clinical decision support (CDS) in the CPOE EHR system.
Examples of basic CDS would include drug-allergy, drug-route, drug-drug,
drug-dose for single doses, and therapeutic duplication contraindications.
Examples of more advanced CDS would include drug-laboratory, drug-dose for
daily doses, drug-age, drug-diagnosis, and corollary orders contraindications.
The test patients
are downloaded into the CPOE EHR system and then a clinician enters medication
orders on those patients. The primary outcome measure is whether the hospital
CPOE EHR system correctly generates an alert, warning, or soft or hard stop
after entering a test order that could have caused an ADE.
Hospital EHR’s did
better on some categories than others. For example, they did best on the
drug-allergy category in each year, increasing from 92.9% in 2009 to 98.4% in
2018. The lowest performing category throughout the study was drug-diagnosis
contraindications, where the mean score was only 20.4% in 2009 and 33.2% in
2018.
Regarding EHR
vendors, there were 30 vendors across hospitals, and the authors found fairly considerable variation across vendors.
The editorial accompanying the Classen paper (Ratwani 2020) suggests that The Joint Commission could adopt the Leapfrog CPOE EHR simulation tool as part of their hospital accreditation program. In addition, the Office of the National Coordinator for Health Information Technology (ONC), which oversees EHR technology, should include safety certification criteria as part of their voluntary certification program. But he notes that certification alone is not enough, because EHR’s are often configured, customized, and maintained by each health care facility in different ways. He also suggests creation of a safety reporting system, like those that exist for medications and medical devices, for EHR’s.
If your hospital is not already participating in the Leapfrog CPOE EHR simulation tool program, you should be. It can help you identify critical vulnerabilities in your medication safety efforts and show you areas of opportunity for improvement.
See
some of our previous columns dealing with the Leapfrog CPOE EHR evaluation
tool:
July 27, 2010 “EMR’s
Still Have a Long Way to Go”
June 2012 “Leapfrog
CPOE Simulation: Improvement But Still Shortfalls”
April 23, 2013 “Plethora
of Medication Safety Studies”
March 2015 “CPOE
Fails to Catch Prescribing Errors”
May 3, 2016 “Clinical
Decision Support Malfunction”
November 22, 2016 “Leapfrog,
Picklists, and Healthcare IT Vulnerabilities”
References:
Classen DC, Holmgren AJ, Co Z, et al. National Trends in the Safety Performance of Electronic Health Record Systems From 2009 to 2018. JAMA Netw Open 2020; 3(5): e205547
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766545
Ratwani RM. Modest Progress on the Path to Electronic Health Record Medication Safety. JAMA Netw Open 2020; 3(5): e206665
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766542
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