Cost concerns limit CPOE implementation

Computerized physician order entry (CPOE) systems can flag potential medication errors and cut the number of serious prescribing errors in half. But cost concerns have limited their implementation to fewer than 5% of U.S. hospitals, the director of medical informatics at a large New York City health provider told a HIMSS audience Tuesday.

"The reason there are so few is because CPOE operates far above the bottom line," said Dr. Glenn Martin of Queens Health Network, which began CPOE adoption eight years ago.

Hospitals have other capital needs with clearer return on investment, which makes justifying the cost of CPOE a challenge, Martin said. In addition to cost of the actual system, institutions often must fund requisite technological infrastructures.

Physician resistance, although not the primary hurdle some believe it to be, is still a significant barrier to broader CPOE acceptance, according to Martin.

"Physicians will accept CPOE if the system operates intuitively and reliably," he said. Vendors must be responsive to physician workflow needs."

Martin said cultural fear of change is actually the largest obstacle in CPOE's path. No matter how it is implemented, CPOE will mean changing what's done (processes) and how they're done (culture), he said.

Queens Health decided on a Big Bang rather than a staged approach to implementation.

"A hospital suffers the same upheaval whether the new application is rolled out to 20 users or 2000," Martin said.

Besides, integrated functionality must be simultaneously implemented across disciplines in order to provide full benefit to the user, he said.

The Hospital of Saint Raphael, a New Haven facility associated with Yale University School of Medicine, took implementation's middle road, staging its CPOE project by bringing up the largest groups first, such as medicine.

Bringing up CPOE one unit at a time was thought to take too long and not work well because patients move among units. The plan proved successful. An estimated 95% of all Saint Raphael physicians are currently using CPOE.

Martin said CPOE immediately improved patient care at Queens Health by giving physicians access to patient data, wherever and whenever they needed it. It actually improved the quality of the information by eliminating a host of transcription errors resulting from illegible comments in medication orders, progress notes, treatment plans, and assessments.

"It's important to remember that patient safety, not return on investment, is the key driver for CPOE implementation," he said.