Leapfrog's Big Leap Into Irrelevance

Inside Healthcare Computing has graciously agreed to make previous Mr. HIStalk editorials available from its newsletter as a weekly "Best Of" series for HIStalk. This editorial originally appeared in the newsletter in October 2006. Inside Healthcare Computing subscribers receive a new editorial every week in their Electronic Update.

I remember sitting in a hotel ballroom back in 2001 or 2002 hearing about The Leapfrog Group for the first time. I was both energized and worried. I liked their idea of pushing a short list of evidence-based quality measures for hospitals to follow. However, I was worried that my own hospital employer might not be able to meet their expectations, thereby raising the ire of the big-employer healthcare dollars behind Leapfrog.

Leapfrog didn’t sound like someone to mess with. The post-dot com era would be bleak, with too many hospital beds competing for the business of the newly savvy baby boomer consumers, capable of making shrewd healthcare decisions because they’d ordered books from Amazon.com.

If the IOM’s “To Err is Human” was embarrassing, Leapfrog was threatening. Their changes were downright prescriptive, encouraging no debate or deviation, and backed by the folks who pay the bills. Experts in their individual Leaps howled to see the evidence behind their choices, but it was not forthcoming.

Somewhere along the line, Leapfrog fizzled. Nowadays, they’re a quaint anachronism. Their role seems mainly to trumpet the accomplishments of other groups on their website.

In fact, I just compared their Members webpage with an archived version from 2004. Today’s count: 44 members. 2004’s count: 152 members. Among the missing: Allscripts, Cerner, Eclipsys, McKesson, Misys, Siemens. I hope no one got hurt in the mass exodus.

A new Leapfrog press release illustrates how little influence they have. They did a study that found over 90% of hospitals have ignored their CPOE mandate. Over 90% don’t meet their standards for two surgical procedures. 70% don’t use intensivists in the ICU as Leapfrog demands. Are they suffering from the financial retaliation of Leapfrog’s few remaining members? Not that I can tell.

Also unfortunate was their inclusion of Indianapolis’s Methodist Hospital as one of their Top Hospitals of 2006, fresh off headlines detailing the deaths of three newborns there due to a medication error. That could have happened anywhere, but the timing was terrible for Leapfrog. To cynics like me, that was yet another indicator of their irrelevance.

I’ll leave other experts to comment on some of the widely ignored Leapfrog standards, but I’m not about to pass up the chance to point out how ridiculous their CPOE requirement is.

CPOE prevents few patient errors. It prevents mistakes, but mostly those that would have been caught anyway by skilled professionals, such as transcription errors and clinically questionable orders. Just about every study done by AHRQ and others have said exactly that: there’s nothing wrong with CPOE, but just don’t expect it to make much of a difference in patient outcomes, particularly considering its immense cost and failure rate.

Leapfrog should have been smart enough to steer clear of the CPOE bandwagon. Maybe they didn’t look around at the available products, small in number and large in functional deficiencies. Maybe their healthcare IT members twisted their arms to sell a few CPOE systems by mandate. At any rate, Leapfrog’s urgings probably sold a lot of CPOE systems, but their own survey shows they aren’t being used. Millions spent with little to show for it, apparently.

It isn’t that healthcare won’t change, it was just that Leapfrog didn’t do it. For those making it happen, check out Don Berwick’s Institute for Healthcare Improvement. If you want to see research in action, look at AHRQ. If you want to see cutting-edge informatics, consider Kaiser or Intermountain Healthcare. For mass market mandates, even JCAHO’s core measures are getting the word out. And if you want to see a group living in its own formerly large shadow, check out Leapfrog.

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