Boston-based CareGroup Healthcare Systems has initiated a provider order entry (POE) system pilot project aimed at reducing medical errors. POE allows doctors to pull patient data from a server fed by the Cach'e database from InterSystems, a database and systems development company.
This initiative is in response to a report from the Institute of Medicine released in June 2001, which stated that more people die each year from medical errors than from car accidents, breast cancer or AIDS.
CareGroup invested $2 million in the POE system in an effort to save lives and costs. The Web-based order entry system replaces all handwritten and verbal orders in the hospital.
"The system allows physicians to enter every medication, lab, dietary, radiology and general care order via the Web," says Dr John Halamka, CIO of CareGroup. "In addition, doctors can now use PCs and wireless protocols to enter these orders, as Palms have too little screen space for such an application."
After examining a patient a doctor can decide on appropriate action, like prescribing medication. POE applies rules to double-check the doctor`s decision and to determine if the specific medication and dosage is appropriate for the patient based on other medications the patient is taking, the patient`s weight or the availability of newer drugs. The doctor then assesses POE`s feedback, decides which course of action to pursue and executes it. POE communicates with robotic drug-dispensing machinery in the hospital`s pharmacy.
Many clinicians were against using computers and thought the order-entry system would be time-consuming. In an effort to alleviate opposition, the development team assembled a guiding coalition of physicians, nurses, pharmacists and ancillary staff.
With 12 000 employees, 3 000 doctors and 9 million patients in the CareGroup system, scalability was an issue, as well as performance, security and reliability. "CareGroup chose the Cach'e database because it provided everything in one tool," says Halamka. "We handle 900 transactions a second in our clinical system and relational databases like Oracle could not offer this transactional performance."
The Cach'e system runs on two HP 9000s, one of which is always on standby to prevent downtime and data loss. An EMC storage tower hosts the database, and users access the application through Web browsers. Dual-processor Compaq Web servers, triply redundant with automatic fail-over run Windows 2000 and Microsoft Internet Information Server.
The 20-person development team consisted of 11 software developers and nine application specialists, with a total of 403 years clinical experience among them. Key developers wrote the Web tools used to design the system and then trained team members in the technology before getting underway.
"Management of the CareGroup organisation and the user community consider the project a success," says Henry Adams, country manager of InterSystems South Africa. "It has eliminated 50% of medication errors and takes no additional time. Key to its success was the early physician involvement in the development of the system and the training that was provided because POE is 15% technology, and 85% process and organisational change."
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