CPOE and Patient Safety

Longhurst: Yes, particularly from the experiences of the Seattle, L.A. and Boston children's hospitals; and we feel a tremendous debt to all of them.

HCI: Were there any special or particular challenges in terms of the go-live itself?

Longhurst: One of the important things-we have some of the highest acuity of any children's hospital in the United States. In fact, in the fall of 2009 through the fall of 2010, we ranked as having the highest-level acuity in case mix of any children's hospital in the U.S. We're really a quaternary children's hospital.

HCI: What were your overall goals in leveraging CPOE for care improvement?

Longhurst: Pre-go-live, our project had really been pushed to the board as a quality and safety effort; and I credit my colleague Paul Sharek, M.D., our chief quality officer, in helping to promote that. So this had always been looked at as a quality and safety project, and really, from the outset of the capital project, it was viewed as clinical transformation leveraging information technology to produce process redesign.

HCI: So your study was a natural outcome of that?

Longhurst: Well, prior to the study, what we had put together was a dashboard for our board of directors with 32 different indicators, specific to the project. The 32 different indicators included a variety of things; some were metrics that we had already been tracking, and that we then included on the CPOE/EMR dashboard; others were specific. So for example, we tracked CPOE adoption rates and verbal order rates very closely. We also tracked turnaround times for laboratory, medication and radiology orders. In some cases, the metrics were unique to the project; in other cases, such as with lab turnaround times, we had been tracking time from sample accession to result availability; that's sort of a classic lab measure. But we wanted to look at the time from order to result for a stat, one-time order.

And then finally, another piece of that dashboard was actually our mortality data. And that was on our EMR dashboard because of the Pittsburgh Children's experience. Our project had kicked off in January 2006, which was a month after the publication of the Children's Pittsburgh article about their experience of having a bump in mortality following their go-live in the 2002-2003 period, though published in December 2005.

HCI: So you were concerned about that?

Longhurst: Yes, we were particularly concerned about the impact on children's hospitals, and particularly among children's hospitals that used Cerner.

HCI: How did your study come about-the one that led to the 2010 article that you and your colleagues authored, in Pediatrics?

Longhurst: It really was an outgrowth of the board of directors dashboard work. The mortality bump from Children's Pittsburgh really was all from the first three months following go-live. And Mark Del Beccaro [Mark Del Beccaro, M.D., CMIO, Seattle Children's Hospital] produced data showing that there hadn't been a bump in mortality. So we really stood on the shoulders of those who came before us, in particular Pittsburgh, Seattle, and Los Angeles, that they had shared with us.

We were relieved, of course, that we didn't see a bump in mortality in the first six months post-go-live; and we were actually gratified that we started seeing a decrease in mortality shortly after go-live, but that this lower rate continued. So 15 months after go-live was in 2009, and we said, we should really share our experience. Eventually, we ended up with 18 months of data showing that our mortality was dropping, so at that point, we decided we should write this up. And the various articles have built on each others' findings. Pittsburgh Children's published in 2005; Seattle Children's published their no-mortality-increase data in late 2006; we went live in 2007; and we published our data in 2010.

HCI: To what do you essentially attribute your decrease in mortality?