The AMDIS Connection | Challenges of Leapfrog CDS Certification

Computerized physician order entry (CPOE) and clinical decision support (CDS) are among the most beneficial and transformative elements of EHRs. However, the process in which hospitals prove their effective use of these tools is challenging. 

The Leapfrog Group patient safety score is the clear benchmark for CDS. Certification requires hospitals to take a test—the CPOE Evaluation Tool), which is a remote test for use by hospitals to assess their compliance with The Leapfrog Group’s CPOE patient safety standard. Leapfrog’s CPOE standard requires that hospitals:

• Assure that prescribers enter hospital medication orders via a computer system that includes decision support software to reduce prescribing errors; and
• Demonstrate, via a test, that its inpatient CPOE system can alert physicians to at least 50 percent of common serious prescribing errors.

A test may be taken only once every six months. To complete a CPOE evaluation, a hospital must first have submitted a 2013 Leapfrog Hospital Survey and indicated in its survey response that a CPOE system, meeting Leapfrog’s criteria, is already operating in at least one inpatient department or area of the hospital. 

The process sounds simple on paper, but it can be extremely difficult in the real world. The test is taken by a single hospital only, which makes it difficult for independent delivery networks with multiple hospitals. Hospitals’ lack of standardized processes mean many organizations struggle to keep the same code and latest versions of the EHR across the health system. There is a lack of test patients or domains where providers can practice test taking as well as a deficit of knowledge for test preparations.

These Leapfrog CDS system criteria are based on the ability of the EHR to alert physicians for therapeutic duplication, drug-dose, drug-allergy, drug-route, drug-drug interactions and more. Having an EHR without these alerts results in hospitals getting an incomplete evaluation—the worst grade.

During the 2013 AMDIS Physician-Computer Connection Symposium, David Classen, MD, MS, who works with Leapfrog in developing these CDS system criteria, informed AMDIS members that he is working on fine-tuning these criteria so that the organizations taking the test find it easier to comply and can design their systems around the recommendations of the test. 

As a medical informatics physician and leader in the field, along with the AMDIS community, I am extremely hopeful of a better future where hospitals across the nation adopt these safe CDS standards.