We thought we would be perfect: medication errors before and after the initiation of Computerized Physician Order Entry

Schwartzberg, David M.; Ivanovic, Sasa; Patel, Sheetal; Burjonrappa, Sathyaprasad

doi:10.1016/j.jss.2015.03.004

Cited by 15 publications

(18 citation statements)

References 16 publications

(29 reference statements)

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“…Hospitals adopting health IT anticipate learning costs and prepare clinicians with training and support months in advance of implementation. Despite the preparations, significant usability challenges and unexpected errors are inevitable . Analogous to adoption of health IT, the remediation activities to improve security in health IT systems following a breach introduce new changes into complex work environments, which may disrupt care processes and explain our findings of reduced quality …”

Section: Resultsmentioning

confidence: 99%

“…[12][13][14][15] Furthermore, changes in HIT systems are associated with learning, training, and support costs that may raise usability challenges and unexpected errors. 16 Remediation efforts to repair the damage from a data breach and improve security incur financial costs. 17,18 Our analysis focuses on the relationship between breach remediation and hospital quality ( Figure 1B).…”

Section: Conceptual Modelmentioning

confidence: 99%

“…Despite the preparations, significant usability challenges and unexpected errors are inevitable. 16 Analogous to adoption of health IT, the remediation activities to improve security in health IT systems following a breach introduce new changes into complex work environments, which may disrupt care processes and explain our findings of reduced quality. [56][57][58] Health data breaches have significant consequences for patients, providers, and payers and contribute to quality of care problems.…”

Section: Con Clus Ionmentioning

confidence: 99%

“…Remediation activity may introduce changes that delay, complicate, or disrupt HIT and patient care processes . Furthermore, changes in HIT systems are associated with learning, training, and support costs that may raise usability challenges and unexpected errors . Remediation efforts to repair the damage from a data breach and improve security incur financial costs .…”

Section: Introductionmentioning

confidence: 99%

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Data breach remediation efforts and their implications for hospital quality

Choi

Johnson

Lehmann

2019

Health Services Research

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Objective To estimate the relationship between breach remediation efforts and hospital care quality. Data Sources Department of Health and Human Services’ (HHS) public database on hospital data breaches and Medicare Compare's public data on hospital quality measures for 2012‐2016. Materials and Methods Data breach data were merged with the Medicare Compare data for years 2012‐2016, yielding a panel of 3025 hospitals with 14 297 unique hospital‐year observations. Study Design The relationship between breach remediation and hospital quality was estimated using a difference‐in‐differences regression. Hospital quality was measured by 30‐day acute myocardial infarction mortality rate and time from door to electrocardiogram. Principal Findings Hospital time‐to‐electrocardiogram increased as much as 2.7 minutes and 30‐day acute myocardial infarction mortality increased as much as 0.36 percentage points during the 3‐year window following a breach. Conclusion Breach remediation efforts were associated with deterioration in timeliness of care and patient outcomes. Thus, breached hospitals and HHS oversight should carefully evaluate remedial security initiatives to achieve better data security without negatively affecting patient outcomes.

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Section: Resultsmentioning

confidence: 99%

Section: Conceptual Modelmentioning

confidence: 99%

Section: Con Clus Ionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Data breach remediation efforts and their implications for hospital quality

Choi

Johnson

Lehmann

2019

Health Services Research

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“…Previous studies have compared medication errors before and after CPOE implementation. [5][6][7][8] Comparisons of verbal, unsigned, and duplicate orders for laboratory tests, pharmacy, and radiology before and after EHR have also been made. [9][10][11] The percentage of missed tests (orders with no result), added tests (results with no orders), illegible requests, and transcription errors (erroneous test name) have been identified as quality indicators (QI) in laboratory medicine.…”

Section: Introductionmentioning

confidence: 99%

Laboratory Order Errors Before and After Implementation of Electronic Health Record

2016

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An analysis of laboratory order entry errors on randomly selected inpatient records was conducted comparing errors 12 months before and after implementation of an electronic health record (EHR) at a 571-bed community health system. Methods: A total of 720 medical records were reviewed with 10,176 orders before EHR implementation and 11,455 orders after. Errors evaluated included unsigned, duplicate, illegible, and omitted orders, results with no order, and transcription errors. Data analysis included the independent-samples t-test and Pearson Chi-square test.Results: There was a significant difference in laboratory order entry errors before and after EHR implementation (p<0.05). The percentages of unsigned orders decreased from 8.6% to 7.6%. Orders with missing results decreased from 16.5% to 11.3%, and duplicate orders decreased from 9.1% to 5.8%. Added, illegible, missing, and incorrectly transcribed orders with previous rates of 3.72%, 0.8%, 2.8%, and 0.9% were eliminated. Conclusion: Implementation of an EHR appears to improve clinical laboratory order entry. ABBREVIATIONS: CMS-Centers for Medicare & Medicaid Services, CPOE-computerized physician order entry, CQM-clinical quality measures, EHRelectronic health record, LOS-length of stay, LISlaboratory information system, HIS-hospital information system, HIM-health information management, HPF-horizon patient folder, QI-quality indicator, IQR-Interquartile Range.INDEX TERMS: Electronic health records, medical order entry systems, hospital information systems, centers for Medicare and Medicaid services (U.S.), medical errors, patient care, patient safety Clin

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