Computer Beats Paper for Prescribing, Study Finds

Teryl Nuckols, MD, MSHS

The computer beats paper when it comes to prescribing drugs and ordering laboratory tests at hospitals, according to a study led by Teryl Nuckols, MD, MSHS, director of the Division of General Internal Medicine in the Cedars-Sinai Department of Medicine.

The study, published in the Joint Commission Journal on Quality and Patient Safety, found that computerized provider order entry (CPOE) reduced prescription errors and saved money. This method involves physicians entering their orders into computers, which transmit them directly to pharmacists and lab technicians, rather than writing them down on paper.

The research team compared CPOE with paper ordering among patients admitted to 3,912 acute-care hospitals in the U.S. Using a decision-analytical model, the researchers compared the rates of preventable adverse drug events — injuries resulting from medication errors — generated by these two ordering methods and the associated costs, such as additional treatments and hospitalizations. They also took into account the amount of staff time required to order drugs and tests, as well as the expense of instituting and maintaining CPOE systems.

Implementing CPOE in a hospital had, on average, more than a 99 percent probability of yielding savings to society and improving health, the team found. While results varied by hospital size, the data showed that even small institutions would have more than 70 percent probability of savings.

Nationwide, implementing CPOE could potentially save billions of dollars and improve the lives of thousands of patients. Over the long term, if 85 percent of U.S. hospitals were to adopt CPOE, the financial savings to society would total $133 billion, the data indicated. In addition, about 201,000 quality-adjusted life years — a measurement of health outcomes based on length and quality of life — would be gained.

Pharmacist Ainslie Cheung, PharmD, fills an order in Cedars-Sinai's Advanced Health Sciences Pavilion Pharmacy. Computerized entry of prescriptions by physicians can reduce errors and costs, according to recent research.

"Over the lifetimes of patients admitted to the hospitals using these systems nationwide, it appears likely that society would more than recoup the shorter-term implementation costs," Nuckols said.

Use of CPOE has been spurred by the 2009 Health Information Technology for Economic and Clinical Health Act. This law required that hospitals demonstrate "meaningful use" of electronic health record (EHR) systems by 2015 or face fines. One criterion for meaningful use is CPOE, along with a "clinical decision support system," which provides clinicians with automated reminders and recommendations to optimize the safety and quality of clinical decisions.

As of 2012, about 44 percent of general acute care hospitals had EHR systems with CPOE for medications, according to one study cited by Nuckols. In surveys, nonparticipating hospitals reported concerns about the costs of implementing CPOE and the additional time it might take for physicians to enter orders on computers. Among the findings of the study was that changes in workflow did increase physician costs but also decreased costs for nurses and pharmacists.

The study was accompanied an editorial in the Joint Commission Journal on Quality and Patient Safety by Emily Beth Devine, PhD, Pharm, MBA, from the University of Washington, Seattle. Devine stated that Nuckols' study "represents the most comprehensive estimate conducted to date of the societal value of the nationally recommended strategy of widespread adoption of CPOE/CDS (clinical decision support) systems in the inpatient setting."

Besides Nuckols, the study involved researchers affiliated with the National Committee for Quality Assurance in Washington; RAND Corp. in Santa Monica; Stanford University in Palo Alto, California; David Geffen School of Medicine at UCLA; UCLA Jonathan and Karin Fielding School of Public Health in Los Angeles; Vanderbilt University School of Medicine in Nashville, Tennessee; and U.S. Department of Veterans Affairs Palo Alto Health Care System in Menlo Park, California.