Meaningful Use Makes Lower Adverse Drug Rates A Reality
Judy Murphy, R.N. and Jon White, M.D. Former Deputy National Coordinator, Office of the National Coordinator for Health IT | August 15, 2014
When the Health Information Technology for Economic and Digital Health (HITECH) Act was passed in 2009 as part of the American Recovery and Reinvestment Act, hopes were high that widespread use of electronic health records (EHRs) would reduce the rate of adverse drug events in hospitals. Advocates believed incentives that encouraged hospitals and physicians to adopt EHRs would not only encourage faster adoption, but help to improve patient health.
A new study funded by the Agency for Healthcare Research and Quality (AHRQ) found Florida hospitals that adopted all five core measures of meaningful use for medication management in 2010 had the lowest rate of adverse drug events of all hospitals in the state. Hospitals that identified medication management as a major concern had the highest rate of adverse drug events, followed by hospitals that had not yet adopted any of the measures.
The specific medication management measures are:
- Using computerized provider order entry (CPOE) systems for medication orders
- Implementing decision support systems to check for drug-drug and drug-allergy interactions
- Having the capability to electronically exchange key clinical information (such as medication lists, medication allergies, and test results) with other providers
- Maintaining an active medication list, and
- Maintaining an active medication allergy list
The study also affirmed another powerful force facing hospitals in deploying EHRs to reduce adverse drug events: physician resistance.
Hospitals where physicians objected to adopting HITECH’s meaningful use measures for medication management saw their adverse drug events increase by 14 percent, compared to a 52 percent reduction at hospitals where physicians supported the medication management meaningful use measures. Even hospitals that cited costs as a main barrier to adoption of medication management measures reduced their drug errors by 35 percent.
To gauge the impact of adoption of medication management measures on hospital-caused drug errors, the study authors examined three data sets:
- The 2010 Florida State Inpatient Database, which is part of AHRQ’s Healthcare Cost and Utilization Project and contained information on all 2.6 million hospitalizations;
- The information technology supplement of the American Hospital Association’s 2010 annual survey, which asked about meaningful use adoption for the first time; and
- Medicare’s 2010 Hospital Compare data, to use Medicare’s hospital quality measures.
In 2010, 6 percent of Florida hospitalizations involved an adverse drug event, but only 1.7 percent of them occurred in the hospital. Applying that finding across Florida hospitals, study authors looked at the effect of using medication management measures to address drug errors across different categories of hospitals.
More than one-third (37.9 percent) of hospitals perceived that their top two challenges related to medication management; they had an adverse drug event rate of 2.25 percent. The next highest rate, at 1.72 percent, was among hospitals that had not adopted any of the five medication management measures. Low-quality hospitals, identified by Medicare’s Hospital Compare database, had an adverse drug event rate of 1.65 percent, followed by hospitals where physician resistance was high (1.61 percent).
The lowest adverse drug event rate (1.36 percent) was seen in hospitals that adopted all five medication management measures, followed by hospitals that were ranked by Hospital Compare as high quality (1.37 percent).
Because this study uses data from 2010, it captures performance by Florida’s early adopters. Only 9.9 percent of hospitals in the state had adopted all five core meaningful use medication management functions that year.
Since then, it’s safe to conclude that the rising tide of meaningful use payments to hospitals, which reached $6.8 billion in late 2013, has pushed more hospitals to adoption of medication management measures.
What’s less certain is whether increased adoption of EHRs has significantly lowered adverse drug rates in hospitals and addressed the strong effects of physician resistance. Answers to these questions are critical to ongoing EHR buy-in and continued improvements in hospital patient safety.
Jon White, M.D., is Director of Health Information Technology at the Agency for Healthcare Research and Quality. Judy Murphy, R.N., is Director of the Office of Clinical Quality and Safety and Chief Nursing Officer at the Office of National Coordinator for Health IT.