While the focal point of computerized physician order entry (CPOE) and decision support tools has been reducing medication errors, end-to-end CPOE is integrated with clinical systems in radiology, cardiology and the clinical laboratory. Utilizing CPOE to order imaging exams, clinicians are provided with alerts and reminders to determine which imaging exam is appropriate for the patient. Technologists never question where the order is; they access it from an electronic worklist. And radiologists are provided with more information about the area of concern and indications as to why the exam was ordered.
Computerized physician order entry (CPOE) refers to a variety of computer-based systems that automate and standardize the process for ordering medications and exams. These electronic ordering systems are equipped with intelligent clinical decision support (CDS) tools, a.k.a. alerts, which provide guidance and incorporate knowledge to assist physicians in entering complete, accurate and appropriate patient care orders.
In the past, providers did not rely on informatics in this realm of patient care. But in the 21st century, both workflow and workload are quite different from years past - physicians are confronted with mass amounts of patient data and medical evidence. CPOE systems with CDS mitigate the pressures associated with information overload.
Despite its benefits, the number of U.S. facilities adopting CPOE is still low (and a little uncertain). According to the LeapFrog Group, a consortium of large employees advocating for the implementation of patient safety technology and practices, fewer that 2 percent of U.S. hospitals have CPOE completely or partially available and require its use by physicians. The First Consulting Group of Long Beach, Calif., puts the numbers a little higher, at 5 percent.
WHAT'S THE HOLD UP?
One of the hindering factors is cost - CPOE systems are very expensive, ranging from $1.5 million to $10 million. The cost of developing and implementing CPOE at Brigham and Women's Hospital in Boston, which is maximizing CPOE for radiology ordering and decision support among other applications, was approximately $1.9 million, with $500,000 maintenance costs per year, according to LeapFrog. Installation of even off-the-shelf CPOE packages requires a significant amount of customization for each hospital and can be very expensive, LeapFrog says.
Time is another hampering factor. Rolling out an order-entry system calls for sophisticated levels of integration, especially if it is enterprise-wide. "The platform is provided by the vendor but the problem is that every hospital's catalog of things that are ordered is a lot different," says Donald Rucker, MD, chief medical officer at Siemens Medical Solutions. "There are a lot [of system features] that [vendors] ship, but there are things that institutions have to do themselves and that means that [CPOE] installs run for 18 months to two years."
And a third stumbling block, cultural change, is a component of time. Analysts suggest that CPOE implementation is 30 percent technology-focused, 70 percent organizational. In addition to increasing competition, staffing shortages, rising costs and HIPAA challenges, physicians must learn how to use the system and accept that orders are made via a computer system versus written by hand. "You need to prove the system's clinical relevance by showing how it is going to clinically improve the lives of the physicians, not just get the bill out the door faster," explains Mike Sommers, CIO of Cook County Bureau of Health Services in Chicago, which implemented CPOE in 2002.
THE BRIGHTER SIDE
Early installations of CPOE at university settings have paved the way for their inclusion in mid-size hospitals and smaller clinics. Industry observers estimate CPOE utilization will increase over the next couple of years.
In the 2004 Leadership Survey conducted by the Healthcare Information and Management Systems Society (HIMSS), healthcare CEOs and other senior executive said patient safety concerns remain top priority. Respondents ranked clinical applications, such as electronic medical records (EMR) and CPOE, 60 percent and 55 percent respectively, as the most important applications to be implemented in the next two years.
In 2003, Sheldon I. Dorenfest & Associates Ltd. of Chicago released a report based on data from more than 1,000 healthcare delivery systems, indicating that 15 percent of U.S. hospitals are in the process of implementing