JACR: If you build it, they will comeImaging CPOE gains acceptance

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Computerized physician order entry (CPOE) of imaging orders has the potential to improve healthcare efficiency, safety and cost-effectiveness, but only if clinicians get behind implementation of such systems. That might not be a problem, however, as an imaging CPOE system with embedded decision support (DS) can be broadly accepted clinically, according to a 10-year study of CPOE use at a large, university-affiliated facility published in the February issue of the Journal of the American College of Radiology.

“Despite growing evidence of its benefits, CPOE adoption has been slow, with only 9.6 percent of U.S. hospitals having CPOE completely available,” wrote Ivan K. Ip, MD, MPH, of Brigham and Women’s Hospital (BWH) in Boston, and colleagues.

To test whether clinicians were open to accepting the use of CPOE and DS systems in the facilities that have adopted them, they measured meaningful use of a web-enabled CPOE system with embedded DS at BWH from 2000, when the system was first phased into practice, to 2010.

Results from the study period included 4.1 million imaging studies, and showed significant increases in meaningful use and adoption of CPOE from 2000 to 2010. The proportion of studies performed with electronically created orders went from 0.4 percent to 61.9 percent, and the proportion of electronically signed studies jumped from 0.4 percent to 92.2 percent. Overall adoption of CPOE rose from 0.5 percent to 94.6 percent during the course of the study.

The authors noted that use of electronically created studies was greatest in the emergency department and inpatient settings, with the outpatient setting having the lowest rates of electronically created orders.

“This difference is most likely attributable to the large outpatient network of attending physicians affiliated with our institution, in which certain practices continue to have administrative staff members who enter radiology orders for physicians,” wrote the authors.

Meaningful use varied significantly among specialties. Dermatology, anesthesiology, general medicine and nephrology had some of the highest rates of electronically created and signed orders. The various surgical subspecialties had the lowest rates of electronically created orders.

“Any processes that negatively affect physicians' workflow are likely to encounter resistance,” wrote the authors, who noted that physicians with the lowest rates of meaningful use of electronically created orders were those who spent significant time away from computers in procedural suites or operating rooms.

“Constant monitoring and feature modifications based on user feedback can enhance the adoption process, as demonstrated by incremental improvement in adoption and meaningful use associated with feature enhancements,” they suggested.