Computerized Physician Order Entry (CPOE)

A new article in the December issue of Pediatrics finds that mortality rates at a major academic hospital more than doubled last year after the implementation of a commercial computerized physician order entry (CPOE) system. The study, which was conducted at Children's Hospital of Pittsburgh, found mortality increased from to 2.8 percent to 6.57 percent. Researchers attribute the jump to the problems doctors and staff had in adjusting to the new system. Criticism of the steep …

Substantial emphasis has been put on getting hospitals to install and use computerized physician order entry (CPOE) systems as a cure for medication errors. But several studies have shown that CPOE systems can cause as many errors as they solve. The problem is that vendors and hospital users have not sat down together to figure out what a useful set of error warnings ought to look like. Blog

> The Department of Justice has asked Pfizer for information on its dealings with physicians. Article (Wall Street Journal sub. req.)

> Research published in the Journal of the American Medical Association finds that PDAs equipped with CPOE tools can help cut down on the overprescription of antibiotics. …

A new journal article published this month becomes the latest to examine the potential pitfalls of IT in the healthcare system, examining a serious prescription error at New York Presbyterian. The authors reconstruct a series of mistakes affecting treatment of an elderly male patient experiencing kidney failure. Human error, poorly designed screens and a lack of warnings led to the mistake, which resulted in the patient receiving more than three times the maximum allowed dose of …

Doctors in the New York Presbyterian Hospital system will use a new artificial intelligence-based database system which recommends suggested courses of treatment based on previous patient outcomes. Unlike many CPOE systems, which generally rely on rules-based decision making, the New York Presbyterian system, called the Patient Health Monitor Project, uses an inferencing algorithm designed by a resident physician. Story

Hospitals and Health Networks has released its annual ranking of the most-wired hospitals in the US. The journal also ranks the 25 most-improved, most-wireless and most-wired small and rural hospitals. Most wired hospitals are much more likely to have most of their physicians using CPOE and medication alert systems -- 41 percent versus 27 percent for all hospitals surveyed and 8 percent for the least-wired. Incidentally, these numbers seem to significantly overstate the accepted …

> You can now read the text of the Department of Justice's opinion on HIPAA, which says the government can't prosecute provider employees who break privacy laws. Story (pdf)

> There are strong indications from Albany that New York lawmakers will pass an infection reporting law. Story

> St. Vincent's Medical Center said it …

The conventional wisdom in health IT is that e-prescribing cuts down on preventable medical errors. A study done at the Salt Lake City VA Hospital appears to cast some doubt on that conclusion. A joint team from the University of Utah and the Veterans Administration looked at adverse drug events and found a much higher than expected number of ordering errors.

The authors conclude that decision-support software is needed to help physicians make better use of CPOE systems. The study …