I wrote weekly editorials for a boutique industry newsletter for several years, anxious for both audience and income. I learned a lot about coming up with ideas for the weekly grind, trying to be simultaneously opinionated and entertaining in a few hundred words, and not sleeping much because I was working all the time. They’re fun to read as a look back at what was important then (and often still important now).
I wrote this piece in October 2006.
Leapfrog’s Leap into Irrelevance
By Mr. HIStalk
I sat in a hotel ballroom back in 2001 or 2002, hearing about The Leapfrog Group for the first time as an IT director in a large IDN. Like most people in the room, I was both energized and concerned. I liked the idea of a short list of evidence-based hospital quality standards. However, I worried that my hospital might have a tough time meeting them, thereby raising the ire of the big-employer healthcare dollars that were supposedly backing Leapfrog to the hilt.
Predictions were dire back then in the post dot-bomb nuclear winter. Hospitals would be wildly overbedded. Savvy baby boomers, emboldened by buying books and dog food online, would be calling the shots, making shrewd healthcare decisions and choosing providers based on stringent quality measures that would be plastered all over the Web. Unfocused, change-resistant hospitals, which included all the ones I’d ever worked for or heard of, would be road kill.
If the IOM’s “To Err is Human” was embarrassing to hospitals, Leapfrog was threatening. Their mandates were prescriptive, concentrating on “just do it” guidelines. If you didn’t like their requirements, that was just too bad. Cisco and GM and other big employers had already decided you’d have to play ball their way for a change. Medical experts in fields that were covered by the Leaps howled, demanding to see the evidence supporting them, but it was not forthcoming. Leapfrog wasn’t looking for a debate.
Somewhere along the line, Leapfrog fizzled, surprisingly but decisively. Nowadays, they’re a quaint anachronism. The “news” on their site is mostly press releases applauding the accomplishments of other groups. Their 2004 website listed 152 members; now it has just 44. Among those that bailed were most of the HIT vendors: Allscripts, Cerner, Eclipsys, McKesson, Misys, and Siemens. I hope no one got hurt in the stampede for the exits.
I hadn’t even thought of Leapfrog for months until they issued a press release last week. Instead of containing major announcements of accomplishments or new guidelines, it described their self-commissioned survey that, ironically, laid bare their astounding lack of clout. Hospital compliance with their much-feared CPOE mandate was less than 10%. Over 90% of hospitals don’t meet Leapfrog standards for two surgical procedures. Intensivists in the ICU are used by only 30%. Apparently the risk of retaliation from the tiny band of surviving Leapfrog members isn’t much of a threat.
Maybe the timing wasn’t so good to name Methodist Hospital of Indianapolis as one of their Top Hospitals of 2006, sharing headlines with a string of medication errors that occurred there, some of which killed three newborns. Got CPOE? Check.
CPOE prevents errors, but rarely prevents significant patient harm, making it a bottom-feeder in the “bang for the buck” category of patient safety technologies. Documented successes are nearly non-existent. Still, Leapfrog pushed it as a must-have above all else, undoubtedly with few objections from its HIT vendor members who were happy to move some low-demand product, even if customers signed up out of fear alone.
It’s ironic that hospitals are stuck with white elephant CPOE systems because Leapfrog insisted on them. It’s sad that hard-won capital was diverted from better, cheaper, easier technologies that might have saved some patients instead of just keeping a now-irrelevant trade group happy. I think of those dead babies a lot, trying to decide if just maybe Leapfrog’s CPOE tunnel vision did more harm than good.