A new study published in Health Affairs suggests that Stage 1 meaningful use criteria for use of computerized physician order entry systems is probably too low to significantly lower mortality rates among heart patients, but higher levels of mandated use in Stages 2 and 3 "is more consistently associated with lower mortality."
Stage 1 of meaningful use requires electronic orders for at least 30 percent of eligible patients. The Stage 2 measure likely will be 60 percent with Stage 3 at 80 percent.
Researchers at RAND Corp. studied data from the American Hospital Association Annual Survey database, comparing medication orders written electronically with manual orders. "We relied on self-reported ranges--for example, 26 to 50 percent of patients--of the use of electronic medication ordering and did not have direct measures against which to validate these reports," according to the study. "It was not possible to match our data exactly to the thresholds prescribed in the meaningful use regulations because our data used ranges instead of, for example, a threshold of 30 percent of patients. Therefore, we were not able to simulate the impact of the uptake of electronic medication ordering at the exact thresholds prescribed in the meaningful use regulations. However, our data did provide thresholds that approximate those of the regulations, and we believe that the results of our simulation will be informative to policy makers."
Hospitals that reported any level of use of electronic medication orders had lower mortality rates for three conditions studied. "In unadjusted comparisons, any use at all of electronic medication ordering was associated with significantly lower mortality from heart attack, heart failure and pneumonia," according to the study. "Adjusted comparisons confirmed a statistically significant relationship between the use of electronic medication ordering and mortality rates for heart attack and heart failure, but not for pneumonia."
The study also compared mortality rates among hospitals with different levels of electronic medication order entry. Results showed relationships between the level of electronic ordering and lower mortality from heart attack and heart failure, but not pneumonia. In particular, a relatively lower level of electronic ordering was associated with lower heart attack mortality, while a level of more than 50 percent for heart patients more consistently showed lower mortality for both heart attack and heart failure patients.
The authors hypothesize that failure to find improved mortality rates among patients with pneumonia may be attributable to different patterns of use across conditions, or that different conditions are more or less sensitive to use of electronic ordering. "For instance, the features offered in computerized provider order entry systems may be more useful in safely managing medications for complex chronic conditions such as heart failure than they are for acute conditions such as pneumonia."
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