Tuesday, August 10, 2010

CPOE adds to GRACE

Many of you have expressed an interest in GRACE (Global Risk Assessment and Careplan for Elders). This is an experimental protocol designed to improve the care of all hospitalized elders admitted to BIDMC, with the hope that we will reduce the risk of delirium, falls, pressure ulcers, and functional decline.

A key component of GRACE is its integration with our computerized provider order entry system. Here is a recent article on that from Scientific American, which in turn is based on an (unfortunately subscription-required) article in the Archives of Internal Medicine. Here's an excerpt, quoting Doctor Melissa Mattison on our staff:

"Our study found that when doctors were alerted that the drugs they were ordering could pose a danger to older hospital patients, the orders dropped almost immediately," said Mattison, who was the first author on the study.

After the new CPOE function was installed at BIDMC in 2005, the orders for potentially inappropriate medication (PIM) for older adults dropped—and stayed—some 20 percent lower than what they had been (down from an average of 11.6 a day to 9.9 a day).

"Many drugs commonly used today have not been tested in seniors or elderly patients," Mattison said. "As a result, a dose that is appropriate for a younger adult may lead to potentially harmful side effects in older individuals, who tend to metabolize medications more slowly."


Anonymous said...

Given the beating that CPOE systems have taken from docs out there, hopefully this post will convince people that it does perform an important function.


Anonymous said...

The 'beating' that we doctors give to CPOE is because the system is mostly designed without optimal workflow in mind nor time given to improve the workflow before putting an IT solution in place. At BIDMC, we build our own CPOE which means we can customize to our liking but that is also a major downfall since we don't get annual enhancements determined by the knowledge and experience of many other organizations as in commercial IT solutions. Maybe we have the advantage of making an initial big step that works perfectly for us in that moment in time but we are quickly overtaken by those who choose the standard route and have more market power to effect change once the solution is delivered. They are therefore better able to handle the changing climate in healthcare. Thank you for an interesting blog!

Anonymous said...


Maybe we both have a case of the grass is greener; I have always thought BID benefited from its superior in-house IT abilities. Having spent my career as a hospital-based doc in community hospitals with large enterprise IT systems (and poor inhouse support), my impression of "market power" and "annual enhancements" is not so favorable. Much of our time was spent beating on the vendor to even make things functional, much less up to date.....

nonlocal MD