CPOE reduces likelihood of error by nearly 50% [article]? I’m skeptical

There’s quite a bit of talk floating around the internet about a recent article in JAMIA that looks at reduction of medication errors in hospitals secondary to CPOE adoption (J Am Med Inform Assoc doi:10.1136/amiajnl-2012-001241). The article is available for free so I read through it last weekend. By the end I was looking at something that wasn’t all that impressive. The authors use a lot of sleight of hand, i.e. statistical models to tell a story about how CPOE “decreases the likelihood of error on that order by 48%”, which ultimately could potentially lead to a reduction in medication errors by approximately 12.5%”. That would be great, except that the entire thing is based on statistical models, assumptions, survey data and a great big meta-analysis.

ChiefStatistian
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CPOE failure modes and effects analysis brings up some good questions

A Failure modes and effects analysis (FMEA) is basically a methodology for predicting potential pitfalls in a project and preemptively finding solutions. This is in contrast to a root cause analysis (RCA) in which case you figure out what went wrong after the fact. Kind of like asking “what could make a plane crash and how to prevent it?” (=FMEA) versus “what made the plane crash and how do we prevent it from happening again?” (=RCA).

My current position is the first in which I’ve been involved in an FMEA, and I’ve personally found them to be powerful tools. We did an FMEA prior to implementation of our BCMA system and came up with what I thought was a pretty good list of things to look out for. Of course what the administration chooses to do with that information is a different story, but at least it’s available if needed.
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Update: Siemens Innovations 2010 final day

Today is my final Day at Innovations and I’ve managed to pick up quite a bit of good, useful information that has the potential to improve our operations back at the hospital. I’ve been in my current position as an IT pharmacist for about 2 1/2 years now and this is my third Innovations conference. I finally have enough experience under my belt to start putting the pieces together in a manner that allows me to gather information in a more strategic fashion, rather than just running around trying to gather enough information to put out fires.

This years Innovations conference was heavy with sessions on ARRA, meaningful use and CPOE. I’m not surprised as this is where all the money will be for vendors involved in HIT over the next several years.

Anyway, I feel there are a couple of presentations I attended yesterday that are worth mentioning.
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Quick Hit – CPOE, a pharmacist’s time and laughter

We’ve finally stepped off the curb and are moving full speed ahead with our CPOE implementation. As a result I spent quite a bit of time last week with our Siemens assigned CPOE consultant. He’s a pharmacist which makes things nice because we understand each other and speak the same language.

The goal of one of the meetings I attended last week was to discuss the resources necessary to implement a CPOE system. Needless to say the project is going to be resource heavy. When it came time to tease out the IT pharmacist part of the project I was a little surprised at what I heard. The time requirements weren’t surprising – several hundred hours – but where the pharmacist fits into the entire scheme was.
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