Morath helped launch a crusade at Children’s to eliminate medical errors through a series of several initiatives, leveraging a $20 million investment in a hospital information network to improve patient safety. Systemwide computerized order entry is part of that network. The hospital chose Cerner’s Hospital Information System because of its decision-support functionality, says James Levin, medical director of informatics for the hospital group. For example, caregivers using the new system will have access to a patient’s full medical record and will be able to see how certain lab test results have changed over time. The computers will also signal correct drug dosages and possible drug interactions. Over the next year, Children’s will progressively roll out the system starting in the Minneapolis center.

Children’s is one of a growing number of midsize hospitals buying vendor-supplied computerized systems. Those who have designed order-entry systems in-house say most medical centers can and should consider off-the-shelf versions. "It’s a tricky and risky process, and the results can be mediocre if you do it yourself," says Glaser. "The products out there are getting much better."

Morath’s approach goes beyond upgrading technology. For example, hospital staff members are required to report all mistakes that harm or come close to harming patients. Also, specially trained doctors and pharmacists are assigned to floors where children get the most complex treatments. She clearly holds great hope for the new computer purchase, which will integrate two separate systems used since the Minneapolis and St. Paul hospitals merged in 1994.

The Children’s example shows that while systems are available, most health-care centers need to tailor store-bought versions for their own needs. The Cerner system includes an order-entry module to help providers calculate dosages and check for drug interaction. Children’s is adapting the software, however, because many calculations didn’t account for the lower body weights of the hospital’s young patients.

Saving Patients, Saving Costs

Sitting in his crowded office at Brigham and Women’s, Bates boasts of his five computers and Palm Pilot, and delivers an animated description of Partners’ plans to roll out an electronic outpatient records system. About 20 percent of the hospital group’s 3,500 doctors are using electronic records, and Partners plans to cover every physician over the next five to six years. The investment is sizeable, but hospital officials estimate annual savings of $9,000 to $20,000 a year per doctor by reducing the overhead of writing prescriptions.

"Soon it will be possible for IS to anticipate the needs of clinicians at the point of care," Bates says. For example, if a doctor orders a toxic antibiotic, such as gentamicin, the electronic record-on a secure, Web-based system-will instantly provide information on other medications the patient is taking and indicate possible drug interactions. "In the not-too-distant future, the computer might be able to suggest new trials on the topic," Bates says.