The amount of data in our world has been exploding, and analyzing large data sets—so-called big data— will become a key basis of competition, underpinning new waves of productivity growth, innovation, and consumer surplus, according to research by MGI and McKinsey's Business Technology Office. Leaders in every sector will have to grapple with the implications of big data, not just a few data-oriented managers. The increasing volume and detail of information captured by enterprises, the rise of multimedia, social media, and the Internet of Things will fuel exponential growth in data for the foreseeable future.

Big data: The next frontier for innovation, competition, and productivity

This review found that 4 benchmark institutions have done most of the published research on the effects of the electronic health record on medical care. The research shows that electronic health re...

Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care

America's health care system has become too complex and costly to continue business as usual. Best Care at Lower Cost explains that inefficiencies, an overwhelming amount of data, and other economic and quality barriers hinder progress in improving health and threaten the nation's economic stability and global competitiveness. According to this report, the knowledge and tools exist to put the health system on the right course to achieve continuous improvement and better quality care at a lower cost.The costs of the system's current inefficiency underscore the urgent need for a systemwide transformation. About 30 percent of health spending in 2009--roughly $750 billion--was wasted on unnecessary services, excessive administrative costs, fraud, and other problems. Moreover, inefficiencies cause needless suffering. By one estimate, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state. This report states that the way health care providers currently train, practice, and learn new information cannot keep pace with the flood of research discoveries and technological advances.About 75 million Americans have more than one chronic condition, requiring coordination among multiple specialists and therapies, which can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions, and dangerous drug interactions. Best Care at Lower Cost emphasizes that a better use of data is a critical element of a continuously improving health system, such as mobile technologies and electronic health records that offer significant potential to capture and share health data better. In order for this to occur, the National Coordinator for Health Information Technology, IT developers, and standard-setting organizations should ensure that these systems are robust and interoperable. Clinicians and care organizations should fully adopt these technologies, and patients should be encouraged to use tools, such as personal health information portals, to actively engage in their care.This book is a call to action that will guide health care providers; administrators; caregivers; policy makers; health professionals; federal, state, and local government agencies; private and public health organizations; and educational institutions.

Best Care at Lower Cost: The Path to Continuously Learning Health Care in America

Objective. In response to the landmark 1999 report by the Institute of Medicine and safety initiatives promoted by the Leapfrog Group, our institution implemented a commercially sold computerized physician order entry (CPOE) system in an effort to reduce medical errors and mortality. We sought to test the hypothesis that CPOE implementation results in reduced mortality among children who are transported for specialized care. Methods. Demographic, clinical, and mortality data were collected of all children who were admitted via interfacility transport to our regional, academic, tertiary-care level children’s hospital during an 18-month period. A commercially sold CPOE program that operated within the framework of a general, medical-surgical clinical application platform was rapidly implemented hospital-wide over 6 days during this period. Retrospective analyses of pre-CPOE and post-CPOE implementation time periods (13 months before and 5 months after CPOE implementation) were subsequently performed. Results. Among 1942 children who were referred and admitted for specialized care during the study period, 75 died, accounting for an overall mortality rate of 3.86%. Univariate analysis revealed that mortality rate significantly increased from 2.80% (39 of 1394) before CPOE implementation to 6.57% (36 of 548) after CPOE implementation. Multivariate analysis revealed that CPOE remained independently associated with increased odds of mortality (odds ratio: 3.28; 95% confidence interval: 1.94–5.55) after adjustment for other mortality covariables. Conclusions. We have observed an unexpected increase in mortality coincident with CPOE implementation. Although CPOE technology holds great promise as a tool to reduce human error during health care delivery, our unanticipated finding suggests that when implementing CPOE systems, institutions should continue to evaluate mortality effects, in addition to medication error rates, for children who are dependent on time-sensitive therapies.

http://www.snubi.org/~juhan/Futurefile/Unexpected%20Increased%20Mortality%20after.pdf

Unexpected Increased Mortality After Implementation of a Commercially Sold Computerized Physician Order Entry System

In the United States, approximately 14 million people have had cancer and more than 1.6 million new cases are diagnosed each year. However, more than a decade after the Institute of Medicine (IOM) first studied the quality of cancer care, the barriers to achieving excellent care for all cancer patients remain daunting. Care often is not patient-centered, many patients do not receive palliative care to manage their symptoms and side effects from treatment, and decisions about care often are not based on the latest scientific evidence. The cost of cancer care also is rising faster than many sectors of medicine--having increased to $125 billion in 2010 from $72 billion in 2004--and is projected to reach $173 billion by 2020. Rising costs are making cancer care less affordable for patients and their families and are creating disparities in patients' access to high-quality cancer care. There also are growing shortages of health professionals skilled in providing cancer care, and the number of adults age 65 and older--the group most susceptible to cancer--is expected to double by 2030, contributing to a 45 percent increase in the number of people developing cancer. The current care delivery system is poorly prepared to address the care needs of this population, which are complex due to altered physiology, functional and cognitive impairment, multiple coexisting diseases, increased side effects from treatment, and greater need for social support. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis presents a conceptual framework for improving the quality of cancer care. This study proposes improvements to six interconnected components of care: (1) engaged patients; (2) an adequately staffed, trained, and coordinated workforce; (3) evidence-based care; (4) learning health care information technology (IT); (5) translation of evidence into clinical practice, quality measurement and performance improvement; and (6) accessible and affordable care. This report recommends changes across the board in these areas to improve the quality of care. Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis provides information for cancer care teams, patients and their families, researchers, quality metrics developers, and payers, as well as HHS, other federal agencies, and industry to reevaluate their current roles and responsibilities in cancer care and work together to develop a higher quality care delivery system. By working toward this shared goal, the cancer care community can improve the quality of life and outcomes for people facing a cancer diagnosis.

/pdf/delivering-high-quality-cancer-care-charting-a-new-course-2u1fq5ml3k.pdf

Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis

Objective. Medication errors are a major concern of health care professionals and medical institutions, especially errors involving children. Studies in adults have shown that computerized physician order entry (CPOE) systems reduce medication errors and adverse drug events (ADEs). The effect of CPOE implementation in a pediatric population has not been reported. The objective of this study was to evaluate the impact of CPOE on the frequency of errors in the medication ordering process in a pediatric critical care unit (PCCU). Methods. A prospective trial was conducted of 514 pediatric patients who were admitted to a 20-bed PCCU in a tertiary-care children’s hospital before and after implementation of CPOE. Medication errors were identified after review of all orders during the study period and then further classified as potential ADEs, medication prescribing errors (MPE), and rule violations (RV). Results. A total of 13 828 medication orders were reviewed. Before implementation, potential ADEs occurred at a rate of 2.2 per 100 orders, MPEs at a rate of 30.1 per 100 orders, and RVs at a rate of 6.8 per 100 orders. After implementation, the rate of potential ADEs was reduced to 1.3 per 100 orders, MPEs to 0.2 per 100 orders, and RVs to 0.1 per 100 orders. The overall error reduction was 95.9%. Potential ADEs were reduced by 40.9%, and MPEs and RVs were reduced by 99.4% and 97.9%, respectively. Conclusions. The implementation of CPOE resulted in almost a complete elimination of MPEs and RVs and a significant but less dramatic effect on potential ADEs.

Computerized Physician Order Entry and Medication Errors in a Pediatric Critical Care Unit

The authors describe design, implementation, and use of a new order entry system module for neonatal intensive care. WizOrder is a Computerized Provider Order Entry (CPOE) system developed at Vanderbilt University Medical Center. Since WizOrder's introduction in 1995, it has been continually refined and enhanced; especially when new hospital units and specialties are implemented. Recently, in March 2003, WizOrder was updated and implemented in the Neonatal Intensive Care Unit (NICU).

Enhancing Computerized Provider Order Entry (CPOE) for neonatal intensive care.

Computerized provider order entry (CPOE) offers the opportunity to enhance communication to prescribers regarding the actions of the Pharmacy and Therapeutics (P&T) Committee. This includes formulary decisions, cost-containment strategies, and medication safety initiatives. In a system of paperbased orders, it can be challenging for prescribers to know what drugs are on formulary or are restricted to certain specialty services. Much of the responsibility for contacting the prescribers regarding nonformulary choices and restrictions lies with the pharmacist processing the order. CPOE allows for this information to be presented to the prescriber at the time of ordering and provides alternative agents when available. This article presents examples of the use of CPOE to implement P&T actions at Vanderbilt Children’s Hospital (VCH).

Computerized Provider Order Entry - Using Computerized Provider Order Entry to Implement Actions of the Pharmacy and Therapeutics Committee

This continuing feature describes the clinical pharmacy support tools and services that are provided by the computerized provider order entry (CPOE) system at Vanderbilt University Medical Center (...

Implementation of Pediatric-Specific Decision Support in a CPOE System

Medications given by continuous infusion are a mainstay of therapy in pediatric and neonatal intensive care units. Administering medications by this method allows for titration of doses by simple rate adjustments. Many pediatric hospitals have traditionally used weight-based calculations such as the “rule of six” to determine the concentration to which a medication will be diluted. The “rule of six” calculation involves multiplying the patient’s weight by six to determine the amount of drug in milligrams to be added to 100 mL of diluent. The infusion rate then equals the dose in mcg/kg/min. This formula, while providing an easy method to determine rate adjustments, can lead to medication errors due to the many possible concentrations that are required to meet the needs of patients of varying weights. One of the 2005 National Patient Safety Goals set by the Joint Commission of Accreditation of Healthcare Organizations required institutions to standardize and limit the number of drug concentrations available in order to prevent medication errors. All institutions must implement this standard by 2008. This paper describes the development of standard concentrations at the Monroe Carell Jr. Children’s Hospital at Vanderbilt and the implementation of the standards using our computerized provider order entry system (CPOE).

Lorianne Wright

Papers

Computerized Physician Order Entry and Medication Errors in a Pediatric Critical Care Unit

Enhancing Computerized Provider Order Entry (CPOE) for neonatal intensive care.

Computerized Provider Order Entry - Using Computerized Provider Order Entry to Implement Actions of the Pharmacy and Therapeutics Committee

Implementation of Pediatric-Specific Decision Support in a CPOE System

Implementation of Standardized Concentrations for Continuous Infusions Using a Computerized Provider Order Entry System