March 15, 2005

Dear Colleagues,

A study published in the March 9, 2005 issue of the Journal of the American Medical Association, raising questions about whether computer physician order entry (CPOE) systems increase medication errors, prompted a story in The Sun that naturally caught our attention.

We wish to assure you that the CPOE system used at Hopkins is the latest, most sophisticated program currently available and specifically is designed to address the problems cited in the study and help prevent them from occurring.

The study conducted over a four-month period in 2002-2003 by the University of Pennsylvania Health System (UPHS) dealt with a first-generation CPOE, the Eclipsys 7000 system, then used by UPHS at the Hospital of the University of Pennsylvania. The Eclipsys 7000 is not the system used at Hopkins (and it is being replaced at UPHS). At Hopkins, we have Eclipsys’s latest-generation system, the Sunrise Clinical Manager. It has features that rectify the limitations in the old CPOE’s capabilities.

For example, the Eclipsys system at Hopkins includes features such as:

• A sophisticated rules and alerts engine and embedded evidence-based clinical content to minimize or eradicate the 10 errors cited in the UPHS study.
• Duplicate medication alerts designed to prevent medication discontinuation failures.
• Advanced rules and alerts carefully designed and implemented to address issues of Immediate Orders and Give-as-Needed Medication Discontinuation Faults, Diluent Options and Errors, Allergy Information Delays, and Conflicting or Duplicative Medications.
• Tall Man lettering and five-rights automation designed to prevent incorrect selection of medications.
• Clear log on/log off that is automated by workstation inactivity.

As noted in The Sun story, UPHS found that nearly three-quarters of the house staff, attending physicians and nurses interviewed or shadowed during the study reported that their reviews of a patient’s medications or dosages were frustrated by not being able to view all of the patient’s drugs on a single screen. They complained of having to scroll through as many as 20 screens. Hopkins’ system displays approximately 20 medications on a single screen.

The UPHS study found that its CPOE crashed two or three times a week, with downtimes of at least 15 minutes being common. The Hopkins system’s backup— “redundancy”—has enabled JHH to have continuous, planned “uptime” 24x7, with no system crashes since the current Eclipsys product was installed in June 2004.

The UPHS’s old CPOE sometimes inexplicably assigned a medication to the wrong patient. With Hopkins’ considerably enhanced system, the electronic transmission of orders to the pharmacy requires that unique patient identification data be included with each order. Mismatches of patient data on the receiving system immediately go to an error log. JHH’s sophisticated interface provides multiple layers of matching requirements so that medications cannot be assigned to the wrong patient inexplicably.

In The Sun story, Peter Provonost, co-chair of Hopkins’ patient safety committee, noted that during a nationwide study of medical errors, he found that staff at other hospitals uniformly complained that they were not trained enough on the new computer systems. Hopkins has learned from these lessons, Peter says, and has invested heavily in training to make CPOE part of our large, overall safety effort.

Patient safety is our top priority. Technology plays a pivotal role in preventing errors. We have the best CPOE on the market—and when improvements become available, we will adopt them.

Stephanie Reel
Vice President, Information Services,
Johns Hopkins Medicine
Chief Information Officer and Vice Provost
for Information Services, The Johns Hopkins University