May 7, 2010

A groundbreaking study from researchers at Lucile Packard Children’s Hospital (LPCH) and Stanford University School of Medicine has shown that using a computerized physician order entry system (CPOE) can reduce hospital mortality rates.

Over 18 months at the LPCH the hospital experienced 20 percent fewer deaths. Although researchers acknowledged that other improvements in patient care could have had an impact on the statistics.

About 10 percent of hospitals nationwide now have CPOE systems, said Eric Widen, Director of Performance Improvement at LPCH. He said the study’s outcome was expected, it just hasn’t been published before now. It was published online on May 3 in Pediatrics, the Official Journal of the American Academy of Pediatrics.

He added that there’s not much argument in the industry over whether or not to use CPOE technology, it’s an issue of cost.

From 2003 to 2007 LPCH, a 272-bed hospital, spent $70 million installing its system by Cerner Corp. of Kansas City, Mo. Cerner holds an estimated 80 percent of the CPOE pediatric market, Widen said.

Other large hospitals like Stanford Medical Center, Kaiser Permanente and Sutter Health hospitals have systems made by Epic Systems Corp. of Verona, WI.

There have been other studies done that have shown a rise in mortality rates or no change in those rates with CPOE systems. Widen says CPOE technology is becoming more mature and sophisticated and people are getting smarter about how to implement the technology.

CPOE systems allow doctors to order medications, tests and treatments electronically so that the instructions are available to all hospital staff, even off site, at all times.  And doctors can see the latest test results and even images, like a brain scan.

The systems also make it easier for doctors to follow standard practices for a specific diagnosis. And it can alert doctors to a patient’s allergies or if a medication dose appears to be incorrect.  It also eliminates the risks involved with illegible handwriting in doctors’ orders, Widen said.

“Prior to our report no hospital or medical institution has shown that CPOE can be implemented and actually have an associated decline in mortality,” said Christopher Longhurst, MD, the lead author of the study and Medical Director of Clinical Informatics at LPCH and assistant clinical professor of Pediatrics at Stanford.

After studying almost 100,000 discharges from LPCH from Jan. 1, 2001 to April 30, 2009 the researchers compared the observed mortality with expected mortality. They generated the expected mortality data from a database of 42 tertiary-care, not-for-profit pediatric hospitals like LPCH.

They found that there were two less deaths for every 1,000 discharges at LPCH after the CPOE system was launched. That’s 36 lives in 18 months.

It’s difficult to isolate a single cause of the decreased mortality, Widen admitted. LPCH launched the system in 2007. But in addition to installing the CPOE system the hospital has been working on process and workflow changes, adjustments in ICU staffing, the rollout of rapid response teams and implementing a nursing residency.