Case Study: Hospital's Prescription: A Dose of Database Software

A Boston-based hospital group turns to InterSystems' Cache database technology to help physicians eliminate mistakes when ordering and filling patients' prescriptions.


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Technology has led to countless lifesaving medical advances, such as the mechanical heart, the chip-embedded pacemaker and the CAT scan. Now, technology is catching up to an age-old health care problem -- medical errors caused partly by physicians' poor handwriting.

CareGroup Healthcare System Inc., a $1.6 billion, 12,000-employee operator of six hospitals in the Boston area, recently installed a database software system from InterSystems Corp., of Cambridge, Mass., that takes the guesswork out of pharmacy orders.

InterSystems' Web-oriented post-relational database technology is being used to run CareGroup's new Physician's Order Entry system, or POE. With the POE, instead of writing orders in their own hand, doctors order drugs from any Web browser on any of the hundreds of PCs throughout the hospitals.

The system works via a seamless data connection built on InterSystems' high-performance Cache database, its flagship product. Among the system's benefits is helping to eliminate medical errors often caused when scribbled doctors' orders lead to the incorrect drug or dosage being delivered to hospitalized patients.

But the POE goes far beyond the handwriting problem, leveraging database technology to pull together critical information that helps doctors make the wisest drug decisions while leaving little room for mistakes to take root, according to Dr. John Halamka, CIO of CareGroup.

For instance, he says, at the moment doctors are keying a prescription into a database, the POE links them to, among other things, that patient's medical history. The system advises the doctors on the medically recommended drug options for the patient's exact condition.

It also cross-checks the patient's record, flagging any potential drug interactions, patient allergies, duplicate drug orders and other factors that could lead to medical trouble. "If you try to adjust the dose too high or too low, it wont let you," says Halamka.

Also, the Cache database links the prescription-writing process to lab results and other patient data, such as the digital x-rays and other medical images (which are 100% digital), to help doctors with their orders. Doctors can also read fresh monthly content updates on medical and pharmacy best-practices.

Reducing Human Error

Once the order is relayed to the in-hospital pharmacy system, it activates a device that automatically opens the door to a container that dispenses the proper medicine, which is date and time stamped.

Together the structured system provides checks and balances that heretofore have been prone to human error, according to Halamka, who also serves as associate dean of Harvard Medical School and is an emergency room physician.

The system has been in use since June. "We believe we'll remove at last 50% of all error that takes place in medicine," Halamka says. He estimates 7 out of 100 patients in American hospitals experience a medication error. "From a patient perspective, there's a sense of a safety net" as a result of the new technology. The doctors and nurses also feel that the new system is effective by serving to double-check their work, he adds.

Medical errors are a persistent and costly problem for the health care industry, reportedly leading to more deaths each year than motor vehicle accidents or breast cancer. Each "adverse medical event" costs a hospital an estimated $5,000, Halamka says.


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