By Cindy Atoji

June 17, 2008 | Pushing adoption of computerized physician order entry systems (CPOE) is at the top of Leah Binder’s agenda. She is the newly appointed CEO for Leapfrog and was formerly a hospital executive at Franklin Community Health Network in Farmington, Maine. Recently, Leapfrog began offering evaluation tools to hospitals to test the effectiveness of their CPOE systems. “When we tested this stimulation tool with several hospitals, they were amazed to discover that it revealed major gaps in their systems,” says Binder. She spoke with Digital HealthCare & Productivity about her plans for Leapfrog and the role that information technology will play in them.

DHP: What are your priorities for Leapfrog?

Binder: Leveraging the purchasing power of large buyers of health care to advance transparency and accountability is a solution that is powerful and long overdue. I would like to strengthen Leapfrog’s already quite robust work in promoting patient safety in hospitals, including using our survey results in the field with employers to help drive where their employees seek care. I’d like to improve our transparency process and how we communicate with public so people understand the value of the information we’re providing. I also plan to interest more funding sources and philanthropists in furthering Leapfrog’s missions and goals, and strengthen working relationships between the organization, its members and its stakeholders.

DHP: What’s new in the 2008 Leapfrog Hospital Survey?

Binder: Most importantly is the CPOE evaluation tool. It was developed by a team of researchers from the First Consulting Group and Institute for Safe Medication Practices, and it’s the first, and to our knowledge, only such tool of its kind. It enables hospitals to determine how well their system alerts users to common, serious prescribing errors.

Also for the first time on a national hospital quality survey, we have some new information about certain procedures, including efficiency as well as mortality, particularly around heart disease treatments. This includes acute myocardial infarction and pneumonia. These two represent a large outlay of health care expenditures for private health care plans. We’ve also changed some of our safe practices reporting, adding pressure ulcers and “injuries occurring during the stay,” two hospital-acquired conditions on the list for which CMS (Centers for Medicare and Medicaid Services) has said it will no longer pay.

We’ll also be issuing in August the Survivor Predictor, it’s a tool developed by another team of researchers to predict the likelihood for the average patient of surviving in a particular hospital for a certain procedure. We will take the data from the hospital survey and apply an algorithm and that will be available on our Web site.

DHP: Why is implementation of CPOE so important?

Binder: Studies have demonstrated that CPOE implementation, if it’s done right, can reduce medication errors anywhere from 50 to 100 percent. The evidence is so powerful that we have identified CPOE as one of our most important standards for safe practices in hospitals. Not only we do we advocate that hospitals adopt these systems, but we list them as standard in our hospital survey, so hospitals that don’t have CPOE get “dinged” in a very substantial way. We have seen an increase in percentage of hospitals adopting CPOE. In 2003, 2.54 percent of hospitals responding to our survey said they had CPOE; and in 2007, it was 10 percent, so we saw about a five-fold increase, but it’s still not close to where it should be—we’d like to see 100 percent have CPOE.

DHP: Now that Leapfrog has helped put CPOE on the map, many are asking how well such systems perform.

Binder: Correct, and that is why we are launching this year the evaluation tool which will measure the efficacy of CPOE as it’s administered in a hospital. So we do recognize that it’s not enough to say you have it—you also have to use it well. And I think not only is it a good tool for CPOE, it’s also a good lesson for all of us in what we’ll need to do as we go forward in implementing EMRs throughout the country. We do need to test these systems repeatedly, because sometimes things get lost in translation.

DHP: What did beta testers of the Leapfrog CPOE Evaluation Tool have to say?

Binder: Eight hospitals piloted our CPOE evaluation tool, and they were all surprised at the number of problems that they found, which they were then able to correct. Sometimes the warnings were going to the wrong place; warnings about interactions were going to the pharmacist not to the prescriber, so the pharmacist would have to track down the prescriber and figure out who the patient was. That’s not an efficient or effective way to manage the system. And there were a ton of problems as far as interactions with allergies; dosage problems where they weren’t getting alerts.

Certain providers had customized the tool that they bought and turned off important alerts, so there were problems with having customized the system. So I think it’s to the advantage of the IT industry to make sure that hospitals are regularly testing their systems, because there’s a lot that can happen from the time a system is installed to the time that it is deployed.

DHP: As a former administrator of a small hospital network, how will you bring more focus to rural hospital issues?

Binder: I’m going to be looking at opportunities to work closely with rural hospitals. In some ways, smaller hospitals can implement technology like CPOE faster than larger facilities—as long as they have the money, which of course, is a big question mark. And in doing so, they offer some real lessons for the rest of the hospital community in what works and what doesn’t in implementing and administering the CPOE systems. So I can see rural hospitals having the opportunity to be real leaders as we integrate IT in hospital systems.

DHP: What’s next on the horizon for Leapfrog?

Binder: We’ve gained a lot of momentum in the country in the past few years. I see that momentum building, where we have many business coalitions and hundreds of businesses now involved in using Leapfrog data to do their benefits planning and encourage employees to use safer hospitals. In terms of information technology, I’m hopeful we will be successful in our advocacy of CPOE systems, and ultimately I think we’ll be advocating for EMR.

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