New York City, Wednesday, July 7, 2004—Barriers to hospitals implementing computerized physician order entry (CPOE), including high costs and physician resistance, can be addressed by strong hospital and physician leadership and a focus on the patient safety improvements CPOE can produce, says an article in the July/August issue of Health Affairs. Lack of standards that would allow seamless interaction between CPOE and existing information technology systems also makes hospital leaders wary of paying for a system that might become obsolete and force them to rebuild their entire IT infrastructure, adds the article, based on research conducted with Commonwealth Fund support. That points to the need to ensure that different systems can communicate with each other, the authors say. In "Overcoming Barriers to Adopting and Implementing Computerized Physician Order Entry Systems in U.S. Hospitals," Eric G. Poon, M.D., M.P.H., Rainu Kaushal, M.D. M.P.H., both of Brigham and Women's Hospital and Harvard Medical School, and David Blumenthal, M.D., M.P.P. of Massachusetts General Hospital and Harvard Medical School, and colleagues identify major barriers to implementing CPOE that exist in hospitals despite evidence that the systems are effective in reducing serious medication errors. Their findings are based on interviews with senior managers in a nationally representative sample of twenty-six hospitals that have experience with implementing CPOE. "Hospital leaders, vendors, and policymakers can and should do more to make CPOE feasible for hospitals to implement," said Commonwealth Fund President Karen Davis. "Addressing cost concerns and providing the support physicians need is crucial to moving forward with this new technology, which can reduce the high rate of medical errors in our health care system." According to the article, obstacles to CPOE implementation and policies to overcome them include:
- Physician and organization resistance to implementing CPOE. Doctors often feel that CPOE is not as efficient as traditional paper-based ordering of medications. This resistance can be overcome by strong hospital leadership in support of CPOE, identifying physicians who will champion CPOE, and providing training and support for physicians to fit CPOE into their workflow.
- High cost of implementing CPOE. Hospitals that focus on patient safety as a top priority are better able to justify the investment in CPOE systems, which are estimated to range from $3 million to $10 million. Measuring CPOE's improvements in a hospital's efficiency, such as reductions in delays in patient care through better communication, is another way to make the case for investment in CPOE.
Improving the ability of CPOE systems to communicate directly with existing IT systems is another important way to address cost concerns in hospitals. Vendors should adopt standards to improve interoperability either voluntarily or through government mandates or incentives. Third-party payer incentives through grants, loans or differential reimbursement from the government or private insurers to help defray the cost of implanting CPOE is another way to address concerns about the high cost of CPOE.
- Product and vendor immaturity. Software often must be modified to suit the needs of the hospital. Strategies hospitals have successfully used in selecting appropriate vendors include choosing those that are committed to the CPOE market, who are willing to adapt their product to the hospital's workflow, and are committed to a long-term relationship with the hospital to ensure the system continues to work well. A standardized toolkit that would allow hospital administrators to evaluate and compare vendors would be very helpful in selecting a vendor.
Policymakers can promote the adoption of CPOE by exerting pressure on hospitals to improve patient safety, encouraging public and private payers to provide financial incentives, providing access to capital through grants or loans, and promoting standardization of vocabulary and communication protocols in CPOE systems.