In the United States, only about five percent of hospitals have functioning CPOE systems. Of these, fewer than 20 percent enter more than half of the orders electronically. Montefiore is one of only a handful of medical centres where physicians enter orders exclusively via computer. Across Montefiore's two hospital campuses, more than 9000 orders are entered by physicians every day.
"Achieving the 100 percent CPOE milestone is a significant step in reaching the goal of a fully electronic on-line medical record", stated Matt Berger, MD, a director of the medical service at Montefiore. "We have experienced real and quantifiable improvements in patient care through error reduction, streamlined work flow, and prospective data analysis."
Since it started rolling out CPOE in 1999, Montefiore has seen numerous improvements in the quality of care it provides, including a 60 percent reduction in the time elapsed from writing a prescription to a patient receiving the medication, and a 50 percent reduction in the number of potential prescribing errors. In addition, nurses, pharmacists and ward clerks no longer have to spend valuable time tracking down physicians to confirm illegible orders.
"Because LastWord is an integrated system that incorporates orders, pharmacy and clinical documentation, it enhances the collaboration among physicians, nurses and pharmacists", stated Dorrie Napoleone, director of clinical information systems at Montefiore. "All of the care providers have instant access to the patient's on-line chart, so everyone is working from the same page."
Ordering, the process by which physicians and other clinicians communicate necessary clinical care actions, including use of medications, is an essential part of caring for each patient in a hospital environment. In order to help promote rapid and accurate communication among physicians, nurses, pharmacists, diagnostic technicians, and scores of other hospital team members, both the Institute of Medicine and the employer consortium The Leapfrog Group have called for health care organisations to replace handwritten orders with CPOE.
By entering orders electronically, physicians reduce the risk that a handwritten order may be misinterpreted. Appropriate technology can also ensure that the order is immediately transmitted across the health care organisation, so that all clinicians involved in a patient's care can access the same information. In addition, the technology can bring additional clinical information, such as warnings about possible drug interactions, patient allergies, and overall best courses of treatment, directly to the physician as the order is entered.
Additionally, according to a survey conducted by the American Society of Health System Pharmacists, the top two concerns patients have about hospital visits are being given the wrong medication (61 percent) and being given two medications that interact in a negative way (58 percent).
LastWord and its next generation successor, IDX Carecast, include decision support technology that alerts physicians to potential errors such as dosage outside the usual range, potential adverse interactions between two medications ordered for the same patient, or prescribing a drug to which the patient has a known allergy, as well as duplicate orders of any kind. Montefiore physicians access LastWord from portable computers which are connected via a wireless network, so real time alerts are received at the point of patient care.
Montefiore Medical Center, the University Hospital and Academic Medical Center for the Albert Einstein College of Medicine, is an internationally recognised leader in patient care, education, research and community services. Montefiore provides treatment programmes for patients with all major illnesses and has distinguished centres of excellence in heart care, cancer care, children's health, women's health, and surgery.
Founded in 1969, IDX Systems Corporation provides information technology solutions to maximise value in the delivery of health care, improve the quality of patient service, enhance medical outcomes, and reduce the costs of care. IDX supports these objectives with a broad range of complementary and functionally rich products installed at 3200 client sites. More information on the IDX LastWord solution is available in the VMW June 2002 article IDX to integrate wireless barcode medication charting into Carecast and LastWord.