McKesson - Performance Strategies

Beating "the Odds" of ADEs

By Andrei Gonzales, MD
Product Manager, Physician Solutions
McKesson Provider Technologies

When was the last time you taxied down the runway without at least considering the possibility of an accident at some point in your flight? How often do you think patients in one of our hospitals worry that their physician, pharmacist and nurse will, as a team, make a collective error that results in a preventable adverse drug event? Even with the increasing news reports of preventable hospital errors, most patients trust that their healthcare providers will at least not harm them, and that interventions will improve their health.

The Odds and Perception of Risk
A 2006 annual review of U.S. aircraft accident data found that the overall accident rate was 0.132 per 100,000 hours flown. A recent study by the Massachusetts Hospital CPOE Initiative, called "Saving Lives, Saving Money: The Imperative for CPOE in Massachusetts Hospitals," found that the baseline rate of preventable adverse drug events (ADE) in their study group was 10.4%. The difference in these accident rates is striking — we have a one-in-several-hundred-thousand chance of experiencing an airline accident compared to a one-in-ten chance of experiencing an ADE. Think of the alarm there would be if one-in-ten flights ended in a crash!

While there are many differences between these industries, one of the cultural differences is the perception of risk and the resulting focus or lack thereof on continuous quality improvement. Healthcare has long trusted and relied on the heroic efforts of well-trained and dedicated professionals taking meticulous care in the healing of their patients. As we have seen from the 1999 Institute of Medicine report and many others since then, these efforts are not sufficient to ensure safe care.

Quality Movements in Industry
Quality movements like Six Sigma and Lean Manufacturing focus on establishing a quality process and reducing process variation to create measurable improvements in outcomes. Hospitals have started looking to these methodologies to gain insights in how to improve patient care outcomes by reducing variability in care processes.

Healthcare has a high degree of variability that is difficult if not impossible to eliminate. The job of quality professionals is to carefully analyze processes to find places where variability can be reduced, value added and quality improved. Tools, like information technology, play an important role in process and offer an efficient way to help decrease process variation.

I recently participated in a Lean workflow analysis at a community hospital. The Lean consultants were shocked at the number of process variations possible just to order, dispense and administer a medication. However, the future state workflow created by the group was faster, involved less time for the physician and had a measurable increase in quality based on the legibility and completeness of the orders submitted through a computerized provider order entry/clinical decision support (CPOE/CDS) system.

As hospitals focus more on quality and process, they are looking to information technology as a part of the solution. The Massachusetts study analyzed the preventable ADEs and found that 81% could have been prevented by implementing CPOE.

CPOE — a Path to Quality Improvement
The Massachusetts study recommends that all state hospitals adopt CPOE with clinical decision support by 2011 to help prevent the many errors revealed. The study also discusses the need to drive adoption to realize the full benefits of CPOE, since it is a key factor in reducing process variation and driving high quality care.

There are many paths to improved process and outcomes. CPOE presents an efficient tool to decrease variations in practice, increase consistency, legibility and completeness of orders, and ensure that an entire hospital is following a standard process for ordering and fulfilling key interventions. CPOE can reduce "the odds" a patient and hospital faces of experiencing an ADE. Learn more about this study in the article below.

Andrei Gonzales, MD, is product manager for Physician Solutions at McKesson Provider Technologies. In this role, Dr. Gonzales is responsible for physician-oriented acute care solutions offered by MPT. Dr. Gonzales joined McKesson after holding similar positions at several healthcare technology companies. His background in operations comes from serving as Director of Operations for the Western Institutional Review Board, an IRB overseeing 16,000 domestic and international research studies.


	Each organization evaluates cost vs. return when deciding to implement information technology. The Massachusetts Hospital CPOE Initiative, a collaboration between the Massachusetts Technology Collaborative and the New England Health Initiative, released a study in February 2008 that evaluated the cost of CPOE technology vs. its effectiveness in reducing costs and improving patient care. The study cites a 2001 report published by the Agency for Healthcare Research and Quality (AHRQ) where it was estimated that nationwide, adverse drug events (ADEs) result in more than 770,000 hospital injuries and deaths each year and cost up to $5.6 million per hospital. The AHRQ report estimates that anywhere from 28-95% of these ADEs could be prevented through "computerized monitoring systems." The Massachusetts Hospital CPOE Initiative was formed because there were no studies that focused on the community hospital setting that could show where and to what extent use of CPOE systems would result in quality improvements and savings. The Initiative's goal was to evaluate the cost vs. effectiveness of this innovative technology and identify the cost and quality benefits hospitals could reasonably expect. The Clinical Baseline and Financial Impact Study conducted an in-depth analysis of six Massachusetts community hospitals. The baseline was set by reviewing 4,200 charts to determine the baseline level of preventable ADEs and the unnecessary use of expensive drug and laboratory tests, which could be improved by implementing CPOE. The study characterizes the results as "stunning." The Baseline: Rate of 10.4% of preventable ADEs - meaning one in ten patients suffered a preventable ADE. Cost of CPOE System: The study estimates the average initial cost at $2.1 million, with $435,000 in annual operating costs. Savings with CPOE and Robust Clinical Decision Support: The study found the level of ADEs could be substantially reduced, providing a return on investment in about 26 months. Cost reductions: Annual savings in unnecessary drug and laboratory test use could be $2.7 million. Benefit to Payors: $900,000 for each hospital. Based on the findings for the six hospitals in the study, the report estimates that if all Massachusetts hospitals adopted CPOE, the annual savings for the hospitals and payors could be approximately $170 million, and 55,000 adverse drug events could be prevented every year. Read the entire report for details on the findings.


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