We’ve come a long way, baby: Standards for CPOE intercept 50% or more common prescribing errors—a major improvement when you consider the problems that resulted from handwritten scripts over the years.
Vendor Vexation
Physicians often face the challenge of finding systems and software that integrate successfully with other systems and settings. Dr. Reines says vendors don’t always make widespread system compatibility a priority during product development.
Some data further suggest that e-prescribing products don’t always meet users’ needs. A report commissioned by the California Health Care Foundation evaluated 19 e-prescribing product vendors and found only four offer practical alternatives to more costly and complex prescription writing solutions.
CPOE First … Then E-Prescribing
Before you jump into e-prescribing, Dr. Strong suggests that more hospitals need to implement computerized physician order entry systems (CPOE). CPOE goes beyond prescriptions and enables physicians to electronically order everything from laboratory tests and dietary interventions to nursing care.
CPOE isn’t new; El Camino has used such a system for 30 years. “We are big-time believers in CPOE,” says Dr. Zielzinski. “It has enabled us to reduce a lot of errors.”
Dr. Strong adds that “these systems are better for overall patient through-put. The routing happens as soon as I input the order. There are no faxes, no paperwork, and no delays.”
Other groups also have long promoted the benefits of CPOE. For example, the Leapfrog Group, an organization of large healthcare purchasers, has suggested standards for CPOE systems that can intercept 50% or more of common serious prescribing errors. At the same time, a number of studies have been published documenting the value of CPOE in reducing medication errors and preventable adverse drug events.
Despite the benefits of CPOE, hospitals have been slow to implement it and many physicians oppose its use. “It’s high time we got over that,” says Dr. Strong. “We need to embrace CPOE now. If we do, e-prescribing won’t be such a shock when it comes down the pike.”
When e-prescribing piggybacks a good CPOE system, it will make more sense. “And when e-prescribing is done well, it will make more sense for physicians to embrace it,” he says. “Until then, it doesn’t make sense for most common situations.”
Dr. Zielzinski agrees that physicians and others need to get over their fear of CPOE. “I think you’ll find that CMS, JCAHO, the Leapfrog Group, and others will push more and more for this to happen. It’s the right thing to do.”
When Hospitalists Embrace High Tech
It is important to emphasize that many hospitalists and other physicians embrace technology. “The reality is that physicians come [to El Camino] because of our technology—it’s part of our culture,” says Dr. Zielzinski. When hospitalists join the El Camino staff, they go through a high-tech orientation with a physician trainer.
Pediatric Hospitalist Bettina Ackerman, MD, uses e-prescribing at her facility, Children’s Hospital of Pittsburgh (Pa.), and she likes the system. She admits that certain aspects of the technology can be cumbersome.
For example, “it’s much easier to handwrite certain information, such as complicated dosing instructions that require a lot of text,” she says. Nonetheless, she has seen the benefits as well. “It has drastically reduced medication errors in our hospital. And there is an efficiency that wasn’t there before.”
Dr. Reines stated that hospitalists are like other physicians: Some of them like e-prescribing and other technology, while others don’t. Age isn’t always a predictor, he emphasizes, noting that he is “the oldest physician in his group but I’m also the most interested in technology.” However, he suggested that hospitalists who are “fresh out of training are more used to technology such as e-prescribing. They kind of expect to use it.”