DT: First, they’re choosing integrated systems. They’re integrating EMR, CPOE, pharmacy, and barcoded meds administration. They’re going for a core clinical IS, one that integrates med/surg, the OR and the ER, all together. Second, they’re really starting to look at the impact, and prioritize their efforts, based on the medication safety impact. Because the question, assuming the funding is available, is ‘what is our goal?’ And the pioneers are saying, ‘our goal is medication safety,’ and they’re prioritizing choices based on that. In many places, organizations are asking, ‘should we do CPOE? Should we do barcoded meds administration? And what will have the biggest bang for the buck?’ And medication safety becomes the organizing principle, if you will, that helps them to drive and determine how they’re moving forward, and what compromises they’re willing to make and not make.
Third, they’re becoming much more holistically focused as well, viewing things more broadly, not doing things just for the pharmacy department or for nursing, or whatever; they’re focused on broad goals like medication safety. Fourth, organizations are becoming much more data-driven, continuing to measure their adverse drug events and medication errors, and continuously improving processes. Because putting the systems in, in the first place, is really just the first step. So they’re constantly working to get better at med safety.
MH: What are the smart CIOs doing?
DT: I think that they’re stepping back in some ways and saying, these are performance improvement initiatives, and they must be driven by clinicians. So whereas in the past, IS might have done something like this by itself, they’re standing behind the clinician leaders, saying, OK, you’re the driver, and you, the director of pharmacy and the chief of the medical staff, will drive this. So IT is providing support and the mechanism and the means, but they’re not driving it.
MH: The organizations making the most progress on this are already ones driven by performance improvement and a quest for quality, and have a culture of multidisciplinary collaboration already, don’t you find?
DT: Yes, exactly. Because you won’t be successful in doing things like this, otherwise.
MH: When will we get to a critical mass of a majority of hospitals putting most of these elements in place?
DT: That’s a hard question to answer, because of the current economic environment; but what is happening is that organizations are saying that these investments, these projects, are reasonable, not only because they’re the right thing to do in terms of medication safety, but because they actually have a significant financial payback. So I think it’s still a five-year horizon in terms of most organizations really having moved forward. As of late 2007, you had about 25 percent of hospital organizations that had implemented barcoded meds administration, according to ASHP [the Bethesda, Md.-based American Society of Health-System Pharmacists]. Now, some of the organizations involved are like the VA, which was a pilot organization for that. And if you look at some of the other data we see, somewhere in the neighborhood of 10 or 20 percent of hospitals plan to do so every year. So you’ll be seeing over 50 percent of hospitals doing barcoded meds administration in the next three years. Now, some of the supporting technologies, such as CPOE, are more challenging. But, given some governmental incentives, perhaps you might cross that 50 percent threshold in the next five years or so; it’s around 15 or 20 percent of hospitals now. If the government gives them a little bit more motivation, both in terms of funding and de-funding, we might then get to 50 percent.
MH: CPOE is a critical element of this, to get it right, correct?
DT: Oh, it absolutely is. And if you look at the studies of where medication errors and adverse drug events emanate from, you still see that a little under half of those are coming out of the order entry process, so that’s something you can’t ignore. But where we’re seeing the most effort is not so much in CPOE, which really requires the goodwill of the physicians; instead, we’re seeing progress in areas that they can control internally, especially in terms of medication dispensing, in terms of the use of robots, and of cabinets and carousels. There are lots of things that are becoming more automated and typically make use of barcoding.
MH: Would you agree that public interest and awareness are beginning to accelerate in this area?
DT: Yes, absolutely. Five years ago, you’d almost never come across articles in the mainstream press on medication errors. But about a year or so ago, I started tracking articles on medication errors and safety, and you can’t go a day without a major article on the topic in a major newspaper; and I think that’s only for the good. And I love working on this. I go from hospital to hospital, and I help them improve medication safety; for me, it’s a dream job.
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