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Insurer urges computerized prescriptions at hospitals

Email|Print| Text size + By Patricia Wen
Globe Staff / February 15, 2008

The state's largest medical insurer said yesterday that it will require all the state's hospitals to fully install a computerized medication ordering system within four years or face a loss of lucrative payouts from an incentive program promoting good-quality care.

The announcement by Blue Cross and Blue Shield of Massachusetts was released at the public unveiling of a report that found that one of every 10 patients admitted to six Massachusetts community hospitals suffered serious and avoidable medication mistakes, including severe allergic reactions or dangerous drug interactions.

The study, by Dr. David Bates of Brigham and Women's Hospital, recommended that every hospital in the state use a computerized prescription system.

Researchers said the system's high up-front costs, roughly $2.5 million, would be recouped within two years by eliminating unnecessary medical care resulting from errors, as well as by reducing the use of expensive brand-name and intravenous drugs when cheaper alternatives are available.

Currently, 10 hospitals in the state, mostly Boston's large academic hospitals, have fully adopted the computerized system that requires doctors to type in medical orders, including prescriptions, diagnostic tests, and blood work.

The remaining 63 hospitals, mostly community hospitals, have been slower to embrace the new technology because of the expense associated with starting it up, said Donald Thieme, head of the Masssachusetts Council of Community Hospitals.

Thieme said the council has requested $30 million from the state to help subsidize community hospitals that install the new systems.

Chris Murphy, spokesman for Blue Cross, said the results of the study, sponsored by the Massachusetts Technology Collaborative and the New England Healthcare Institute, demonstrated the urgent need for hospitals to embrace an error-reducing prescription system. He said Massachusetts hospitals will be barred from participating in the insurers' $104 million incentive program if they do not adopt the computerized system by 2012. "The report made it clear that it's something we should do," he said.

Tufts Health Plan also has offered financial incentives for hospitals to adopt this new computerized system, though it has not imposed a deadline for full implementation, said its spokeswoman, Pam Giannatsis.

Dr. Judyann Bigby, the state secretary of health and human services, is looking for ways to help defray the cost of introducing the system in hospitals. She is exploring the possibility that the state's Essential Community Provider Trust Fund, which typically has about $40 million a year, can be used for this purpose, her spokeswoman said.

Money is not the only obstacle to the introduction of the new system in community hospitals, say researchers. Many physicians, particularly older ones, struggle to adjust to a system that requires them to type every medical order, even dietary restrictions for hospitalized patients. Initially, all medical staff members report some disruption to their established routines, researchers say.

Dr. Sam Bagchi is director of hospital medicine at Emerson Hospital in Concord, where the system is in place in many units. There is always an initial learning curve with this new technology, he said, but all physicians ultimately see the benefits in reducing errors.

State Senator Richard Moore, chairman of the Joint Committee on Healthcare Financing, said he wants the state Board of Registration in Medicine to mandate that all doctors seeking new licenses or renewals show a proficiency in using the system.

Thieme said he was startled to learn that the six community hospitals studied had a 10 percent rate of preventable medication errors, but he said he has no reason to dispute the finding.

Patricia Wen can be reached at wen@globe.com.

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