A recent eWeek article cites an Institute of Medicine study that describes the risks we face from medication errors, whether inpatient or outpatient.
Be afraid. Be very afraid.
The article, entitled All Prescriptions Should Be Electronic by 2010, Panel Says, quotes the following numbers:
Studies assessed by the IOM panel found that 450,000 preventable errors occur each year in hospitals, 800,000 in long-term care facilities like nursing homes, and 530,000 during outpatient care of Medicare recipients. The IOM concluded that the numbers in each study were probably underestimated. The number of people who die from such errors was not included in the report, but estimates range from 7,000 to 50,000. The report estimated the cost of medication errors in hospitals alone could have topped $3.5 billion.
An academic healthcare center, or for that matter any tertiary or quaternary care hospital, can easily spend $50 million or more on a comprehensive CPOE. I've heard that some have spent three times that much, though I won't say who it was who told me or what AHC it was. The requirements gathering alone costs millions and takes many months. Smaller hospitals and physician practices pay less and have shorter install cycle times, but then, they have less revenue and less human resource bandwidth with which to do the deed.
I've only been working in a healthcare setting for three years, and in the industry for less than a decade. From the historical lore to which I've been exposed, I gather that CPOE was high on everyone's agenda in the mid-1990's when HIPAA came along. Between Y2K and HIPAA, attention was generally diverted away from CPOE.
If this oral history perspective is true, it's tragic.
Y2K turned out to be a non-event, thanks to everyone's efforts in mitigating proactively. That was worth the effort from a patient perspective, because there was a risk of mission-critical healthcare IT systems becoming unavailable, or worse, giving bad information. People could have died, so in all likelihood many lives were saved and much less-than-fatal suffering averted by Y2K efforts.
HIPAA, on the other hand, while truly valuable at many levels without question, was not a life-or-death issue. If I'm wrong and someone can show me how its risks compare with those cited above, please enlighten me. I would a thousand times rather have someone become aware that I've been treated for depression in the past or that I suffer from inattentive ADD (both true) or even that I was HIV-positive (not true) than die a gruesome death due to a preventable prescription error.
Why am I not blaming the physicians and nurses for the high level of prescribing errors? Because the problem is systemic, not individual. Healthcare professionals - at least all the ones I've known - are a very conscientious lot. What with hospital administrators and tort lawyers breathing down their necks, doctors and nurses are kept well aware of the consequences of their very human limitations.
W. Edwards Deming, the quality guru who with his advice to the Japanese almost single-handedly destroyed the US auto industry, used to say: "Avoid exhortations to the workforce." Getting prescriptions right is a challenge for which information technology is well suited; doctors and nurses should be listening to and caring for their patients, in person, where the nuances of human communication are beyond the reach of IT systems for the foreseeable future.
HIPAA is behind us, and a universal EMR is the next Holy Grail, the next big potential distraction. From my perspective as a healthcare consumer, I'd rather see a prioritized approach to healthcare IT challenges in which patient risk reduction was the first-order triage criterion. This would be the most efficient and practical way to empower healthcare professionals to live up to the standard Hippocrates set in his Epidemics, in which he wrote, "Declare the past, diagnose the present, foretell the future; practice these acts. As to diseases, make a habit of two things—to help, or at least to do no harm." [italics mine]
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