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The long-awaited fourth "leap" in the Leapfrog Group's strategy to encourage quality improvement in healthcare will involve advanced ambulatory electronic medical records systems with integrated prescribing tools that transmit prescriptions directly to pharmacies via electronic data interchange, a patient safety researcher says.

The Leapfrog Group, a Washington, D.C.-based coalition of large employers that seek to improve healthcare by raising standards for purchasing care, has said that it will announce its fourth quality initiative near the end of 2003. The organization has said that the fourth leap would focus on some facet of ambulatory medicine; the first three programs are specific to inpatient care.

Speaking at a symposium on ambulatory computerized physician order entry in Chicago this week, Harvard Medical School instructor Rainu Kaushal, M.D., disclosed that the next step in the Leapfrog Group's agenda "will focus on ambulatory EMR with e-prescribing and direct transmission of prescriptions to pharmacies."

Kaushal is a staff physician at Harvard-affiliated Brigham and Women's Hospital and at Massachusetts General Hospital, the two founding hospitals of Boston-based integrated delivery system Partners HealthCare. Partners researchers are advising the Leapfrog Group on its quality initiatives.

Leapfrog Group Executive Director Suzanne Delbanco is on vacation this week. Another key spokesperson, Leapfrog co-founder Arnold Milstein, M.D., medical director for the San Francisco-based Pacific Business Group on Health, was not immediately available for comment.