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An HIT Moment With … Leah Binder

October 13, 2008 Interviews 3 Comments

An HIT Moment with ... is a quick interview with someone we find interesting. Leah Binder is CEO of The Leapfrog Group of Washington DC.

Healthcare IT insiders and clinicians often criticize Leapfrog’s choice of CPOE as a technology that benefits patients, given that most medication errors that cause serious patient harm involve drug preparation or administration, not ordering, as in the recent Corpus Christi example with heparin. What overwhelming evidence makes CPOE so compelling to Leapfrog that those critics aren’t seeing?

Our fidelity is not to CPOE per se, but to any and all evidence-based best practices for reducing medication errors and improving patient safety. It happens that CPOE emerges as a clear winner in the evidence. We offer a bibliography on our website.

imageAmong the studies: a study led by David Bates, MD, Chief of General Medicine at Boston’s Brigham and Women’s Hospital, demonstrated that CPOE reduced error rates by 55% — from 10.7 to 4.9 per 1000 patient-days. Rates of serious medication errors fell by 88% in a subsequent study by the same group. Another study conducted by LDS Hospital in Salt Lake City by David Classen, MD, demonstrated a 70% reduction in antibiotic-related ADEs after implementation of decision support for those drugs.

Recently there were two small studies suggesting CPOE might not be effective, but our expert panel discounts those studies because they took place in hospitals that deployed CPOE in six days — a ridiculously short time period for implementing any kind of complex system change.

Our experts read the peer-reviewed research. If there are better ways to reduce medication errors we welcome the opportunity to consider it.

Would you say that Leapfrog has had the influence on outcomes and healthcare purchasing that were expected when it was formed in 2000?

Leapfrog’s influence has been nothing short of astonishing in light of its short history. The central tenets of Leapfrog’s mission — transparency, good measures of quality, and rewarding good performance — have literally transformed mainstream health policy in the United States. Leapfrog led the way in innovations and policy priorities, among them:

  • Leapfrog was the first to issue a never events policy, in 2006; now CMS has begun issuing regulations that Medicare will no longer pay for certain hospital acquired conditions, and all national health plans, and more than 60% of Leapfrog-reporting hospitals have followed suit with never events policies of their own.
  • Leapfrog’s focus on paying for value and performance is now a mainstream philosophy. There are over 200 pay for performance programs in the country, including Leapfrog’s own Hospital Rewards Program, which at least one health plan intends to roll out nationally.
  • Leapfrog’s commitment to transparency of quality information was one of its most controversial elements in 2000; today there are a plethora of report cards and other public information purporting to reveal comparative information among hospitals. Nonetheless, Leapfrog’s report on hospital performance remains by far the best and most useful: up to date information, evidence-based, and reported in a way that offers a meaningful comparison among institutions.
  • Drawing on members’ experience, Leapfrog has influenced the design of CMS’ value-based purchasing initiative as well as HHS Secretary Mike Leavitt’s Executive Order incorporating four “Cornerstones of Value-Driven Health Care.”
  • Leapfrog has significant influence in the National Quality Forum, including most recently approval of Leapfrog-sponsored measures on hospital efficiency.

Leapfrog has also seen progress in hospital quality among hundreds of reporting hospitals and raised the bar on patient safety. A recent peer reviewed study from Harvard School of Public Health, consistent with others that have been published on Leapfrog, concluded that hospitals reporting adequate performance on the Leapfrog Hospital Survey have better outcomes than other hospitals in the United States . 

We have not finished our work by any means. Next steps: support and incentivize providers in achieving higher performance, and engage even more employers. Some of our plans: develop best practices for implementing new IT infrastructure that ties to safety, deploy one nationally standardized pay for performance program based on the Leapfrog Survey, support hospitals more in achieving higher Leapfrog standards, and reach out to consumers and employees in new ways to support them in making decisions about providers. 

We are also going to formalize our partnerships with more of the employers now using Leapfrog (the vast majority are not formally members), issue more detailed guidance on implementation of never events, continue our robust partnership with policymakers and like-minded advocates to advance value-driven purchasing, advance a more streamlined and outcome-oriented set of performance measures, and ultimately, of course, improve the quality and safety of care.

All the evidence to date suggests we are on the right track and that we will be very busy in the years to come.

Where does Leapfrog’s mission fit in tough economic times?

There are many questions about who will be in the White House and what will happen to our economy, but one thing can be predicted with near certainty: the Leapfrog vision for health care reform will be a centerpiece. It has to be. Employers and other purchasers of health care will continue to reduce and in some cases eliminate employee health benefits as their profits erode and health costs escalate. In turn, employees will become more price conscious, and shop for the best value. Shopping for value in health care is what Leapfrog is all about.

With all the groups who want to oversee or audit provider performance, why should hospitals participate in Leapfrog’s programs?

Four reasons to start:

  1. Because employers and purchasers of health care want them to. Purchasers pay for more than the care of their employees; they also subsidize the care of other patients when reimbursement for their care is inadequate, such as the uninsured.  Over 4,000 employers and counting participate with and use Leapfrog, and there is no other source of hospital data that employers point to as “their” exclusive survey. The least hospitals can do is devote 40-80 hours of staff time to giving employers the information they ask for, and in the process build trust and good relationships with their regional employers and employees.
  2. Because it is useful. There is no survey tool that offers a better compendium of the best practices in patient safety, and some of the survey content is like getting high-priced consulting for free. For instance, our evaluation tool for CPOE is unique in the nation and offers invaluable information about the performance of IT systems.
  3. Because it is harmonized with others. The measures in the Leapfrog Survey are consistent with NQF-endorsed measures and safe practices, IHI’s 100,000 Lives Campaign, and the Joint Commission.
  4. Because you’re going to see market share and financial reimbursement changes tied to performance on Leapfrog. It is happening now. Many hospitals that perform well on Leapfrog feature that performance on their advertising, particularly in competitive markets. Some employers use Leapfrog scores to determine co-pay levels, and this has a very dramatic impact on patient flow. As changes in our economy and health system are emerging, we see these trends accelerating.

What were the surprises, good and bad, since you took the job?

The biggest “good” surprise is the influence of Leapfrog in Washington health policy circles and among hospitals. I was in Washington for one year about 14 years ago, and the change since then is incredible. 

For instance, at that time, the idea of report cards comparing providers was considered fairly radical and opposed by a wide variety of provider stakeholders. Today, everyone seems to agree it’s a good idea, and they just argue over the format (a very big issue, but still, the progress is substantial). Leapfrog is present at every significant stakeholder forum and regularly consulted by leaders in all branches of government. When Leapfrog summons people for a meeting on an issue, the who’s-who of leaders and experts show up. And among hospitals, where Leapfrog has its share of both passionate supporters and harsh critics, our influence is unquestioned. The visibility enables us to get things done in ways that would be impossible otherwise.

The second biggest “good” surprise: there are thousands more employers involved with Leapfrog than our membership roles would suggest.  That’s also the biggest “bad” surprise — we need them to be counted formally among Leapfrog’s membership, which helps assure we can sustain this remarkable visibility at the national level.

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Currently there are "3 comments" on this Article:

  1. >>> at that time, the idea of report cards comparing providers was considered fairly radical and opposed by a wide variety of provider stakeholders. Today, everyone seems to agree it’s a good idea

    Biased, sweeping statement- if you bring up provider report cards and P4P to physicians you’ll get tied and burned at the stake just about anywhere you go. By this statement, you wish to forward your agenda.

    >>> Among the studies: a study led by David Bates, MD, Chief of General Medicine at Boston’s Brigham and Women’s Hospital, demonstrated that CPOE reduced error rates by 55% — from 10.7 to 4.9 per 1000 patient-days. Rates of serious medication errors fell by 88% in a subsequent study by the same group. Another study conducted by LDS Hospital in Salt Lake City by David Classen, MD, demonstrated a 70% reduction in antibiotic-related ADEs after implementation of decision support for those drugs.

    All I know is that when I think of CPOE I think of 2 articles that have come out in the past where in one the implementation of CPOE had not gone well in one hospital, and something that is generally detested by physicians, and in the other, babies died.

    I tried to find your bibliography on your site, but alas, it wasn’t there. Let show you what I have:

    http://www.emrupdate.com/forums/p/2648/22685.aspx#22685, “Cedars-Sinai Doctors Cling to Pen and Paper”, 3/21/2005

    http://pediatrics.aappublications.org/cgi/content/abstract/116/6/1506, in this URL you will find a study done at a tertiary level children’s hospital where the findings were eye opening- CPOE was associated with an INCREASED mortality among its patients!


  2. In fact I mentioned in my remarks the studies Dr. Borges cites, pointing out that in both studies CPOE was implemented in 6 days–which is not long enough to safely or effectively implement any system in a hospital, much less one as complex as CPOE. Leapfrog’s concern about the importance of proper implementation of CPOE is why we incorporated a CPOE system evaluation tool into our 2008 survey. Here’s the direct link to the CPOE background on our website: http://www.leapfroggroup.org/for_hospitals/leapfrog_hospital_survey_copy/leapfrog_safety_practices/cpoe

  3. Leah’s article is classic “PYA.” there are many things wrong, but I will focus on 2.

    1. Why was so much emphasis placed on CPOE where the software was immature, it was difficult to install, and it was represented as a panacea. Somebody should review how the decision was made.

    2. Think of the safety outcomes that would have occurred if the same money had been invested in systems that reduce hospital acquired infections, reduce Labor and Delivery mistakes, stream line functions in operating rooms, automate nurse charting, etc.

    No matter what you say, although Leapfrog may have raised expectations, they created a wild goose chase and they still have the gall to defend their actions.

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