Despite sophisticated system checks, hospital computer systems do not flag all potentially harmful medication errors. The Leapfrog Group analyzed a study conducted by the Chief of General Medicine at a Brigham and Women’s Hospital in Boston and found that, while computerized physician order entry (CPOE) systems greatly reduce medication error rates, not every hospital has implemented such a system. Additionally, sometimes the systems fail to recognize serious medication errors—even fatal ones.
CPOE systems maintain patient information, including allergies, current medicines, and lab results. When a new medication is prescribed, the system checks it against the existing information for any errors. Leapfrog created an evaluation tool for these systems, which allows hospitals to create simulated patient accounts and then enter a list of orders containing potentially harmful or fatal errors. Only 4 percent of reporting hospitals had failed to implement a CPOE system, which Leapfrog noted was a vast improvement from 2010, when only a third of hospitals had such protections. The surge in CPOE implementation may be attributed, at least in part, to the Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009 (ARRA) (P.L. 111-5).
The 2015 Leapfrog Hospital Survey revealed a significant level of failure to flag potentially harmful drug orders—39 percent were not marked. Even more unsettling, the CPOE systems failed to raise an alarm on 13 percent of potentially fatal orders. These error rates had only improved one percentage point since the prior year. Further analysis showed that the most common errors related to diagnoses, such as prescribing the wrong drug for a condition; drugs that should be reduced due to impaired kidney function; and monitoring (such as failure to remind a physician to test drug levels as indicated).
USA Today pointed out that the Leapfrog survey leaves out over half of the nation’s hospitals, and that many participants decline to take the system test. Some physicians criticize the use of electronic health records at all, believing that complete reliance on these systems is inappropriate, even dangerous.