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They're Making the Case for eMAR

May 13, 2010
by Mark Hagland
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Yet another study has come out to document the tremendous benefits that can be gained via strategic automation of clinical care. In this case, the great folks at Brigham & Women’s Hospital in Boston last week published an article in the New England Journal of Medicine that analyzed “The Effects of Bar-Code Technology on the Safety of Medication Administration.” In other words, the classic closed-loop medication administration involving an eMAR (electronic medication administration record), a full loop of barcoding across the meds administration process, and of course, some level of data analysis to determine the impact of going fully live with a barcoding-facilitated eMAR.

Not surprisingly, the researchers at Brigham & Women’s found that barcode-based eMAR implementation made a huge difference in medication administration errors. In their study, they found that those units that didn’t use barcode-based eMAR saw a medication administration error rate of 11.5 percent, while those that did use the system recorded an error rate of 6.8 percent—a 41.4 percent relative reduction in errors. And the rate of potential adverse drug events (other than those associated with timing errors) fell from a rate of 3.1 percent without barcoded eMAR to 1.6 percent with its use, representing a 50.8 percent relative reduction.

It’s not surprising that this study was undertaken by researchers at Brigham & Women’s, which has long been a pioneer in both automation-facilitated patient safety improvement initiatives and also in the leveraging of clinical data to support studies that in turn promote improved patient safety and care quality, both internally and on behalf of the industry. I interviewed clinician and IT leaders from Brigham & Women’s for both of my books; and they are true industry leaders, people who are helping to move the dial forward towards where the healthcare industry needs to go in the near and long-term future.

And though nothing in the NEJM study was wildly surprising, that is definitely not the point; the point is that we need more studies like the Brigham & Women’s study to continue to cement the case that the smart leveraging of clinical IT for patient safety and care quality improvement really makes a difference, a critical difference if you are among the patients whose potentially devastating medication administration error is averted because of the intelligent application of technology to an area of patient care that has always been fraught with dangers.

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Comments

Joe,
Thanks much!
Meanwhile, thanks for directing me to the HIMSS presentation by Dr. Agrawal and Ms. Glasser. It sounds as though they had produced good results and a good report/presentation.
I don't think you're going too far in lamenting the fact that only a small number of hospital organizations, mostly very large academic medical centers, are publishing in the major journals, in this area instead, I think that element comes out of the reality that only the largest academic medical centers have large enough, full-time-enough, staffs, to be able to produce and publish studies and reports.
So yes, HIMSS does need to take a marketing lesson from B&W... :-)

Mark,
I was literally thrilled to see your post on eMAR. You nailed the issues, both utility and the NEJM/ "we need more stuides" comment.

To that, I would direct you to the HIMSS 2010 presentation by Abha Agrawal MD and Allison Glasser, PT MBA, titled Barcode Medication Administration Implementation in an Acute Care Hospital. It was done at Kings County. They published and presented safety, quality, workload and documentation time. It was done at Kings County, an organization that has been publishing scientifically conducted, carefully measured, before and after experience on BCMA as well as CPOE and clinical Quality documentation for several years.

The eMAR / BCMA study is available from HIMSS's multi-media partner as document 1691-1300-131, both PDF and MP3 are available.

I know of many valid and powerful studies from authors in NEJM on HCIT that appear one or more years earlier at HIMSS. It's time to stop discounting professional societies in relationship to academic researchers (in Academic Medical Centers who haven't developed their own platforms.)   I am disappointed in the common refrain that the major informatics achievements all occur only from four or so academic centers.  Am I going too far there, Mark?  Does HIMSS need to take a marketing lesson from The Brigham?

Mark Hagland

Editor-In-Chief

Mark Hagland

@hci_markhagland

www.healthcare-informatics.com/blog/mark-hagland

Mark Hagland became Editor-in-Chief of Healthcare Informatics in January 2010. Prior to that, he...