Fortune 500 company benefit plans adopting standards for computerized physician order entry

Computerized physician order entry (CPOE), with adequate drug safety screening, soon will be a standard for hospitals that care for the millions of patients covered by employee health plans at many of the nation's Fortune 500 companies. The CPOE standard, which was in the planning stages well before publication of the Institute of Medicine (IOM) report, is one of the patient safety standards being initiated by the Leapfrog Group, a think tank that represents several large employer organizations including General Motors, Pacific Business Group on Health, and the Minnesota-based Business Health Care Action Group. Additionally, the safety initiatives are being supported by the Business Roundtable, a club to which a very large number of Fortune 500 company CEOs belong. The CPOE standard stems from JAMA-published research¹ showing that serious prescribing errors in hospitals can be reduced by 55% with CPOE systems that alert practitioners when drug allergies, drug interactions, and drug overdoses are recognized by the computer software. The purchaser-led effort will call for mandatory physician use of CPOE linked to prescribing error prevention software. To meet the standard, a hospital will have to demonstrate that its software intercepts a minimum percentage of common, serious prescribing errors, utilizing test cases and a testing protocol being developed by ISMP. The protocol will be modeled after the field test published in the February 10, 1999, ISMP Medication Safety Alert! Hospitals will have to warrant their interception rates and publicly post them on an ISMP-designated web site. A date will be set by which hospitals must have these systems in place in order to meet the purchasing standard. The Leapfrog purchasing standards are expected to be finalized and publicly released this year.

One of the recommendations made in the recent IOM report (To Error is Human: Building a Safer Health Care System, Washington DC, 1999, Institute of Medicine) states that public and private purchasers of health care should provide organizations with incentives to demonstrate continuous improvement in patient safety. Look for additional purchasing standards similar to CPOE, where purchasers apply market incentives in order to reward health systems that demonstrate specific quality and safety enhancements.

References: 1) Bates DW, Leape LL, Cullen DJ et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA 1998;280:1311-16.