PATIENTS BENEFIT WHEN DOCTOR USES COMPUTER, NOT PAPER, TO WRITE PRESCRIPTIONS
COLUMBUS, Ohio – Hospitals may be able to significantly cut the time it takes to deliver medications to patients and complete X-rays and lab tests by having doctors fill out orders via computer rather than by hand, a new study suggests.
Results showed that computerized ordering also eliminated prescription drug errors that occurred when doctors’ handwritten prescriptions were misread.
The study found that computerizing physician orders cut medication turn-around times by 64 percent, cut turn-around times for X-rays and other radiology procedures by 43 percent, and reduced turn-around times for lab tests by 25 percent.
Overall, computerized physician order entry (POE) seems to be good for both patients and hospitals, said Hagop Mekhjian, the study’s lead author and chief medical officer for Ohio State University’s health system.
“We found that it enhances patient care by improving work flow and efficiency and by reducing transcription errors,” Mekhjian said, adding that the hospitals initially invested about $5 million in the program.
Even at that cost, introducing a computerized order entry system wasn’t a real burden for Ohio State’s health system, he said.
“There weren’t any significant negative results, despite the major cultural change that stemmed from introducing this new technology. In many cases, work flow accuracy and efficiency were actually enhanced.”
The study appears in a recent issue of the Journal of the American Medical Informatics Association. Researchers compared turn-around times before and after the implementation of computerized POE at Ohio State University hospitals. The university has been using computerized POE in some inpatient units for nearly three years.
The researchers compared data collected prior to implementation of a computerized POE program with data collected after implementation. The data were collected from patient charts and also from watching doctors as they prepared written orders. After POE was in place, the researchers gathered the same type of data electronically.
They kept track of how much time physicians spent on rounds, how long it took to write an order, what time an order was written and when the order made it to its intended destination, such as the pharmacy or the laboratory.
The researchers also measured three events: medication turn-around times (how long it took for a patient to receive a prescribed medication); the amount of time it took to complete a radiology procedure; and how long it took for a laboratory to post test results.
Medication turn-around times decreased by 64 percent, from nearly five-and-a-half hours to just under two hours. Radiology procedure completion times decreased by 43 percent, from just over seven-and-a-half hours to four hours and 21 minutes. Laboratory result reporting times decreased by 25 percent, from 31 minutes to 23 minutes.
“We didn’t expect such significant changes,” Mekhjian said.
When computerized POE was combined with another electronic system that completely eradicated all manual transcriptions, the researchers found that medication errors were eliminated. “Total elimination of transcription leaves little room for errors associated with the interpretation and translation of doctors’ orders,” Mekhjian said.
As many as 25 percent of reported medication errors arise from confusion over the similarity of drug names, according to the National Coordinating Council for Medication Error Reporting and Prevention.
“This is especially true when a doctor gives the orders verbally to a nurse or directly to the pharmacy,” Mekhjian said.
But the greatest advantage of computerized POE, he said, is the way it can speed up patient care in many cases.
Previous studies report that up to one-third of all hospitalized patients experience some kind of delay in their care, with the average length of a delay being nearly 3 days.
“There can be delays in decision making while a physician waits for results, delays in scheduling diagnostic tests and delays in discharge planning,” Mekhjian said. “Entering an order into a computer can help alleviate many of these delays. It also serves as a check-and-balance system to doctors, such as reminding a physician if a prescription needs countersigned.”
While computerized POE helped with order turn-around times, the study showed that it had little impact on hospital costs and stays. The length and cost of stay decreased in a few surgical areas, but overall results were not significant.
“Stay and cost are affected by a number of things beyond the scope of this study,” Mekhjian said.
Although the current study focused solely on inpatients, Mekhjian said that Ohio State is looking into using the system in outpatient clinics.
“That’s a priority for us,” he said. “The outpatient population is considerably different – there is greater diversity among patients’ needs, and things move a lot faster.”
Mekhjian conducted the study with Rajee Kumar, Lynn Kuehn, Thomas Bentley, Phyllis Teater, Andrew Thomas, Beth Payne and Asif Ahmad, all with Ohio State hospitals.