As the first Fort Bend County hospital with electronic medical record (EMR) technology and computerized bedside charting, Memorial Hermann Sugar Land Hospital is taking the final steps to become fully digital. Effective July 5, all patient orders will be submitted via the hospital's computerized physician order entry (CPOE) system and paper orders will cease to exist.
Various studies have credited CPOE systems with a reduction in the rate of serious medication errors. The May 2010 issue of Pediatrics published a study showing a 20 percent reduction in patient deaths at Stanford University children's hospital after implementation of a CPOE system. Another study at Boston's Brigham and Women's Hospital demonstrated a 55 percent reduction in error rates with CPOE. Other studies have shown even higher declines. As a result, experts in healthcare quality and patient safety have urged the inclusion of CPOE into safety standards
With CPOE, physicians enter orders electronically where they are integrated with patient information. Orders are automatically checked and alerts are instantly issued if there is a potential for a patient drug interaction, allergy or overdose. Additionally, CPOE standardizes the entry of orders, thereby eliminating interpretations that can lead to errors.
Memorial Hermann Sugar Land opted for a gradual move to CPOE, also called e-ordering, to provide time for training, usage analysis and software refinement. William B. Riley, Jr., MD, the hospital's chief medical officer, said most hospitals choose to implement the CPOE technology in stages. In fact, The Joint Commission cautions that technologies like EMR and CPOE have a systemic impact on clinical processes that can interrupt care and inadvertently compromise patient safety.
Dr. Riley agrees, explaining that EMR technology exposes flaws in workflows, systems and processes, thereby necessitating improvements that went unrecognized in the paper world. As a result of its own improvements, Memorial Hermann Sugar Land has received both national and state recognition for its quality and patient safety.
"Another way that becoming an early adopter of the EMR technology has positively impacted our quality results is that it reinforces a daily message to all caregivers that we want to be ahead of the curve in healthcare," said Dr. Riley.
Along with enhancing the quality of patient care, CPOE helps reduce costs through improved efficiencies. No longer must physicians or nurses wonder if medications or lab orders were received by the appropriate departments. Because the computer shows orders in real-time, follow-up phone calls are nearly obsolete.
Dr. Riley said the implementation of CPOE started with pilot projects focused on certain medical specialty areas. In addition to formal training, members of the hospital's information technology staff are available 24/7 to support physicians in using the new technology. As a result, Memorial Hermann Sugar Land was able to reach a 70 percent adoption rate.
"You tend to hit a plateau with progressive implementation of e-ordering" said Dr. Riley. "That's when you need to mandate its use. Otherwise the nurses are caring for patients in two worlds - the electronic world and the paper world. This is not optimal for quality care and patient safety. So it's time for us to finish the journey."
Kulvinder Bajwa, MD, past chief of staff at Memorial Hermann Sugar Land, said that moving to 100 percent e-ordering has been underway since the hospital opened in December 2006. As a result, this has forced other area hospitals to start moving to a digital environment. "The reason it's being done is not just competition, but because it's the right thing to do for patients."