Hospital system's online drug system leads to reduce mistakes

Source: eHealth Smartbrief
6 Jun 2008
[based in an interview to Dr. Darrel A. Campbell Jr., conducted by Gary Gosselin from "mLive.com /business review/" (Michigan)]

The University of Michigan Health System has completed a $95 million, three-year implementation of UM-CareLink, an online order-entry system designed to reduce drug errors and phase out paper forms. UMHS was able to slash medication mistakes by 29% in 2007 with the help of the new system.

A big area for hospital mistakes is in medication, mistakes brought to light again May 14, when actor Dennis Quaid testified before Congress about the overdose of Heparin given to his twins.

University of Michigan Health System has moved to stem those types mistakes with a new online order entry system and said it has cut medication mistakes by 29 percent. The health system recently completed a $95 million, three-year implementation of its UM-CareLink, eliminating many paper forms, said Jocelyn DeWitt, chief information officer for the health system. UMHS cut those mistakes in the last year when the system was used for patients in the women's and children's hospitals, accounting for 200 of the system's 809 staffed beds.

At least 1.5 million people every year are injured by medication, according to a 2006 report from the Institute of Medicine of the National Academies. The extra medical costs of treating drug-related injuries occurring in hospitals alone amount to $3.5 billion a year, the study says.

"There is room for improvement everywhere ( said Dr. Darrell A. Campbell Jr., chief of staff and senior associate director) and the UMHS full system rollout provides the opportunity for cutting even more mistakes".

"There are all sorts of ways to stop that. We're not satisfied with any errors," Campbell said. "Medical errors are the No. 1 problem in most hospitals and we think we can get down much more than 29 percent." 

"UM-CareLink allows physicians, nurses and technicians to order laboratory tests, procedures, medications, and nutrition services online from any computer, and has shaved 40 percent off the time between ordering and administration of urgent medications.  More than 5,300 staff were trained in the last year and 1,100 computers and printers", Campbell added.

Nationally, about 17.5 percent of hospitals are using electronic recordkeeping to some degree, according to Healthcare Informatics, a proportion that's expected to hit 50 percent of hospitals by 2014.   Annual health IT spending is expected to increase from $6.9 billion in 2007 to $10.8 billion in 2012, according to a study released by market research firm Input, Government Health IT reports (DeWitt) . 

"The next thing we'll be doing won't cost nearly as much. We'll be doing bar-coding and clinical documentation," DeWitt said .    With bar-coding, a nurse scans the patient's wristband, scans the medicine container and the system automatically checks the drug and dose.  Nurses will no longer have to fill out and update paper patient assessment and flow sheets, DeWitt said, entering everything into the system, saving time and streamlining the process.

"We can build a lot into this system and that's one of the reasons we got this system," Campbell said. " Another program checks for interactions and allergies, and sounds an alarm - with recommendations - if a problem is found.  You have no idea of the complexity of issues for a patient ... There are hundreds if not thousands of protocols for cancer treatment alone," Campbell added.

"One of the problems we have to watch for is called alert fatigue . You can't have too many alerts because people get tired and blow by them," he added . "There is an optimum number and we will find that number. The system can be pre-programmed with order sets outlining protocol, dosage and when they should be administered, taking out an element of human error", Campbell said.

The next step, a number of years down the road, is communicating information across all medical institutions, and UMHS is preparing for that with this system. 

"That's where medical institutions want to get, but first it has to be available within an institution," DeWitt said. "And once that's done we can talk to other institutions about how to transmit information. We are making sure the decisions we make today aren't closing down opportunities in that area."