Although federal lawmakers have committed tens of billions of dollars to incentivize health systems and providers to use electronic information systems to improve patient care, thousands of potentially serious medication errors have been tied to use of computerized ordering of medications.
The National Patient Safety Foundation (NPSF) has awarded a highly competitive research grant to the Center for Patient Safety Research and Practice at the Brigham and Women's Hospital and Harvard Medical School to research errors reported as being associated with computerized prescriber order entry (CPOE). Quantros, Inc., the Silicon Valley-based software company that manages MEDMARX, will partner with the Center on the year-long project. MEDMARX, initially developed by US Pharmacopeia (USP), now owned and managed by Quantros, is a Web-based solution that collects anonymous reports of medication errors. MEDMARX contains more than 1.5 million reports and is now the largest adverse drug event database in the world.
"The overriding goal is to better understand CPOE the technology that has been proven to improve medication safety and evaluate potential problems to make sure that we identify and uproot those problems in the best possible ways," said Gordon Schiff, MD, the Center's associate director and principal investigator of the project. "The overarching goal is to learn from the experiences of people out on the front lines who are using CPOE systems as to some of the potential problems so their efforts in reporting, which is a very important part of our patient safety infrastructure. The rich data from such reports needs to be aggregated across the hundreds of reporting hospitals and analyzed for recurring preventable factors that can be targeted for improving the technology and health care practices."
Researchers from the Center for Patient Safety Research and the Quantros Patient Safety Center, a federally certified Patient Safety Organization at Quantros, will investigate about 200,000 MEDMARX records where CPOE was listed as a contributing factor. The research will focus on such topics as:
• Creating descriptive statistics to analyze the drugs, dosing issues, prescribing and dispensing issues, outcomes and other contributing factors identified by the reporters of CPOE-related errors.
• Extracting insights from report narratives to better understand the nature and mechanism of the reported CPOE-related errors and how better designed systems might have prevented them, and
• Developing and testing a new classification for CPOE-related errors and process failure modes to collect more useful data.
Investigators will also test vulnerability of leading CPOE systems. "Although use of CPOE reduces adverse drug events significantly, there is still room for improvement. This project is about understanding how to further improve CPOE by applying new knowledge from such studies," said Ali Rashidee, MD, MS, Quantros Director for Safety and Risk Management and a principal investigator on the project.
The research project comes amid planned adoption, which holds great promise, of new electronic medical record systems in hospitals and physician offices nationwide, fueled by the American Recovery and Reinvestment Act of 2009 (ARRA), noted Sanjaya Kumar, MD, CEO and Chief Medical Officer at Quantros.
"Our goal is that we use our safety data to understand and provide feedback for furthering point of care systems, such as CPOE systems, so they can be improved upon and made safer," Kumar said.
Schiff added, "We owe it to the people who took the time to document these problems, and learn everything we can from them, not to mention the patients who have experienced problems. We owe it to them to help make sure that future patients don't experience similar problems."
Since its inception, MEDMARX has collected more than 1.5 million medication errors from more than 800 hospitals and health systems. Quantros partnered with the Institute for Safe Medication Practices (ISMP) to help support this medication error reporting function and analysis.
"We offer our congratulations to Dr. Schiff and the team on this important work to identify potential problems with CPOE systems in order to expand their safe implementation and further use," said Allen J. Vaida, PharmD, ISMP's Executive Vice President.
About The Center for Patient Safety Research and Practice
The Center for Patient Safety Research and Practice of Boston is the premier convener of patient safety scientists and investigators from academia, government, industry and healthcare. Based at the Brigham and Women's Hospital and Harvard Medical School, the Center is a multi-institutional organization that works to improve the overall quality of healthcare through scientifically proven systems, methods and practices. The Center is led by Executive Director David Westfall Bates, MD, MSc, Associate Director Gordon Schiff, MD, and Project Director Carol Keohane, RN.
Quantros (quantros.com) is a leading healthcare software and services provider of data management, decision support analytics, and clinical business intelligence solutions for the healthcare industry in areas of safety and risk management, quality and performance improvement, outcomes monitoring and accreditation and compliance. MEDMARX is a medication error and adverse drug reaction comparative data repository specifically designed for advanced analysis and benchmarking.