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CPOE and Patient Safety

May 26, 2011
by Mark Hagland
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The Experience of One Children's Hospital Go-Live Offers Valuable Clues About Automation and Care Quality

When Lucile Packard Children's Hospital at Stanford (LPCH), in Palo Alto, Calif., went live with computerized physician order entry (CPOE) in the fall of 2007, healthcare IT leaders there were able to “stand on the shoulders” of other children's hospitals that had rolled out CPOE in the years immediately prior. Indeed, most of those that had already implemented CPOE were, like LPCH, customers of the Kansas City-based Cerner Corp.: Children's Hospital of Pittsburgh of UPMC (live in 2002); Seattle Children's Hospital and Children's Hospital of Los Angeles (2003); Children's Hospital Orange County (2005); and Children's Hospital Boston (2007). So there was already experience with some of the particular challenges of CPOE go-lives in the pediatric environment, including with a specific vendor solution, says Christopher A. Longhurst, M.D., LPCH's CMIO.

But there were also some concerns, given that James Levin, M.D., Ph.D., and his colleagues had seen temporarily increased mortality levels at Children's Hospital of Pittsburgh, following that organization's CPOE go-live several years earlier, which was described in a December 2005 article in Pediatrics. Levin and his colleagues worked assiduously to determine the causes of the mortality level increases, and were able to reverse those effects at their organization.

In addition, the experiences of all those children's hospitals that had implemented Cerner's core CPOE system strongly informed Longhurst and his colleagues at LPCH. As a result of all the preparations involved, LPCH did not experience even a temporary increase in mortality rates; instead, over time, it experienced a sustained decrease in mortality rates, as Longhurst and eight co-authors have described in a July 2010 article in Pediatrics, entitled, “Decrease in Hospital-wide Mortality Rate After Implementation of a Commercially Sold Computerized Physician Order Entry System.” Indeed, adjusting for a number of complicating factors, Longhurst and his colleagues determined that the hospital had sustained a 20-percent decrease in mortality over the 18-month period of the study that led to the 2010 Pediatrics article.

Christopher A. Longhurst, M.D.
Christopher A. Longhurst, M.D.

Further, Levin and Longhurst co-presented at the annual AMDIS (Association of Medical Directors of Information Systems) conference, held in July last year in Ojai, Calif. Their presentation, “Evidence-based EMR Implementation: Achieving Meaningful Outcomes and Avoiding Unintended Consequences,” was widely regarded as the most impactful of the conference by the assembled CMIOs.

Longhurst spoke recently with HCI Editor-in-Chief Mark Hagland regarding what he and his colleagues at LPCH-and elsewhere-have learned about how to effectively implement CPOE in a pediatric hospital setting. Below are excerpts from that interview.

Healthcare Informatics: Did you and your colleagues create extensive customizations from the core Cerner CPOE solution when you rolled out?

Christopher A. Longhurst, M.D.: Yes, a tremendous amount.

HCI: And you were able to learn from the implementations at those other children's hospitals?