Health Affairs: Real benefit will come later from meaningful use, CPOE
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The study’s authors, Spencer S. Jones, Paul Heaton and colleagues from RAND, assessed the mortality rates of patients within 30 days of being hospitalized for heart attack, heart failure or pneumonia, obtained from mortality data from a September 2008 Centers for Medicare & Medicaid Services (CMS) Hospital Compare database.
The authors sought to evaluate the relationship between electronic medication order entry and hospital mortality. The survey results suggest that the initial meaningful use threshold for hospitals—which require them to use electronic orders for at least 30 percent of eligible patients—is probably too low to have a significant impact on deaths from heart failure and heart attack among hospitalized Medicare beneficiaries.
However, the proposed Stage 2 meaningful use requirements, whereby electronic medication orders are used for at least 60 percent of patients “[are] more consistently associated with lower mortality,” the authors said. “Our results suggest that the higher standard that will probably follow in the second stage of meaningful use regulations would be more likely than the first stage to produce the improved patient outcomes at the center of the federal health information technology initiative."
The authors said that the majority of the hospitals studied did not have electronic order entry for medications (61 percent). Another 13 percent reported using electronic ordering for 1 to 25 percent of patients; 4 percent reported using it for 26 to 50 percent of patients; 6 percent reported using it for 51 to 90 percent of patients; and 16 percent reported using it for 91 to 100 percent of patients.
“When we compared hospitals that reported use of electronic medication ordering to hospitals reporting no use, we found that the first group had lower mortality rates for each of the three conditions studied. In unadjusted comparisons, any use of electronic medication ordering was associated with lower mortality from heart attack, heart failure and pneumonia,” the authors stated. “Adjusted comparisons confirmed a statistically significant relationship between the use of electronic medication ordering and mortality rates for heart attack and heart failure, but not for pneumonia.”
The authors said that as policymakers debate Stage 2 requirements, the study indicates an increased use of electronic medication order entry has the potential to reduce mortality in the future. “We cannot conclude that the relatively low electronic medication ordering threshold embodied in Stage 1 will lead to lower mortality rates,” the authors stated. “However, our results do support the notion that the increased thresholds proposed for later stages have the potential to reduce mortality among hospitalized patients.”
In the 2000 Institute of Medicine report "To Err Is Human," it was estimated that medical errors caused 98,000 deaths each year. “Even after more than a decade of focusing on patient safety, the rates of medically induced harm and death remain unacceptably high,” the authors concluded. “Given this evidence, the findings of our study should be cause for measured optimism that computerized provider order entry, when used frequently, may have the potential to reduce hospital mortality rates.”