Hospitals Lag In Computerized Physician Order Entry

Health IT Boosts Patient Care, Safety

A study that has tracked computerized physician order entry (CPOE) adoption since 2003 shows that more hospitals are using the technology.

Before the passage of the American Recovery and Reinvestment Act of 2009, an average of 87 hospitals went live each year with CPOE. Since ARRA, that number has climbed to 233. The increase shows promise, a KLAS analyst said, but CPOE adoption rates should be further along by now.

"Just over 20% of hospitals in the U.S. were live on CPOE as of the end of 2010 and today it's probably between 20% to 25%," Colin Buckley, co-author of the report, told InformationWeek Healthcare. "That means you've got thousands of hospitals out there that aren't live on CPOE and the majority of those need to be. They don't want to be impacted by Meaningful Use penalties."

Many hospitals, especially those in rural areas, are faced with tight budgets and the reality that installing CPOE can cause disruptions to physicians' workflow, Buckley said. Additionally, CPOE installations are competing with other IT requirements like the need to implement ICD-10 clinical coding systems, putting further strain on IT resources.

Most hospitals are community size ones running on "shoe string budgets," Buckley said. Installing a CPOE has a big impact on things like order sets and training, and requires a change in the culture and process, he said. "These small hospitals have so many things to worry about from an IT point of view, and there's so much that needs to happen in a limited amount of time," Buckley said.

Nevertheless, the CPOE 2011: The ARRA Effect report, which was released last week, reveals that federal incentives are having a significant impact on CPOE adoption rates.

"As Stage 1 meaningful use deadlines approach, more and more hospitals and clinics are adopting CPOE," Jason Hess, lead author of the report, said in a statement. "This tells us that vendors have to be ready to respond to the growing demand--sooner rather than later."

The study highlights data collected from virtually every hospital nationwide that's known to have gone live with CPOE in the last three years. As the number of live CPOE sites increases, the speed and depth of adoption results in new challenges for vendors and hospitals.

Cerner's Millennium PowerChart has more hospitals live with CPOE than any other vendor in the study. Epic is in second place for market share. At Cerner hospitals, 81% of orders have been entered via CPOE on average since 2009. Among Epic hospitals the percentage is slightly higher with an average of 83% of their orders being entered via CPOE. Both Cerner and Epic have about doubled their number of live CPOE sites since 2009, the report said.

McKesson is making progress in CPOE with both its Horizon and Paragon products. The numbers show an increase from 37 to 90 installations of Horizon at the end of 2010. Their new offering, Paragon, brought its first 11 sites live in 2010.

Meaningful Use Stage 1 set the bar for CPOE adoption relatively low, so the biggest hurdle providers must overcome to qualify for MU incentive payments is just getting CPOE live and functioning, Hess said.

"As we move into later stages of MU, CPOE vendors that have worked out how to help customers achieve deep adoption will be the ones hospitals and clinics look to," he said.

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