Dana-Farber then integrated its new software with a physician order-entry system designed by and used at neighboring Brigham and Women’s. The system, known as Brigham Integrated Computing System, cost $1.97 million to develop in 1993 and around $500,000 a year to maintain. Still, Brigham and Women’s officials say it has saved the hospital $5 million to $10 million a year by preventing "adverse drug events," suggesting lower dosages and directing doctors to less expensive drugs. Fewer errors can also translate to lower legal fees. "Our system is very quick and easy to use," says Bates, who is nationally renowned for his quality control research. "The vendor community has lagged behind us."

Other teaching hospitals have developed similar systems. LDS Hospital has cut drug-related errors with a system that checks each patient’s allergies as well as drug-to-drug interactions through links with the blood laboratory and other data centers.

The IOM study found that 50 percent of hospital medication errors stem from the prescription-ordering process. Still, hospitals have been slow to adopt the technology. "A computerized system costing $1 [million] to $2 million could pay for itself in three to five years, while preventing injury to hundreds of patients each year," states the IOM report.

Of the one-third of hospitals nationwide that have installed computerized order-entry systems, only 1 percent require physicians to use them, says Arnold Milstein, a San Francisco physician and national health-care thought leader at New York City-based medical lobby group William M. Mercer. Milstein is on the steering committee of the Leapfrog Group, an association of major health-care purchasers pressing doctors and hospitals to reduce errors. (See "Leapfrogging Ahead," Page 114.)

One of the main reasons for the slow adoption, Bates says, is that vendors haven’t been able to provide shrink-wrapped versions of the systems so carefully and expensively designed at the country’s major teaching hospitals. That’s changing, however, as companies like Cerner and McKesson HBOC develop off-the-shelf versions of order-entry systems and a wide array of technologies ranging from pharmacy robots to handheld scanning devices designed to reduce medication errors.

Over the Counter IT

Julie Morath knows firsthand that medication errors have a devastating effect not only on patients and their families, but on the caregivers themselves. As a young nurse early in her career, Morath, now chief operating officer of Children’s Hospitals and Clinics in Minneapolis and St. Paul, Minn., witnessed a 4-year-old die from an anesthesia-related error. "What was most frightening was that everything looked normal and then there was this devastating event," she says. "Nobody even talked about it. The nurse who felt responsible left and never came back."