Posted by: Jenny Laurello
Computerized physician order entry, CPOE, Meaningful use, meaningful use stage 2, MU, Stage 2
Guest post by: Donald Burt, M.D., Chief Medical Officer, PatientKeeper Inc.
Two years ago, at the dawn of the American Recovery and Reinvestment Act (ARRA) era, computerized physician order entry, or CPOE, was a software application that over nearly four decades had achieved all of 6% market penetration. In other words, it had gone virtually nowhere because CPOE applications were notoriously cumbersome for physicians to use.
Enter the Health Information Technology for Economic and Clinical Health (HITECH) Act and meaningful use. Suddenly, a $20 billion carrot was dangled in front of hospitals, which, among other things, rewarded them for deploying and using CPOE.
Now, halfway through 2012, about 1,000 U.S. hospitals (approximately 20%) have attested to stage 1 meaningful use of CPOE: 30% of their patients have had at least one medication order entered electronically. 1,000 hospitals is a good start, but it is only a start. However, this does not mean that CPOE is entrenched at those 1,000 institutions, because it’s well known that many attested to stage 1 using existing ED or other departmental systems, absent an enterprise-wide CPOE solution. In an article in InformationWeek Healthcare, health care industry research firm Leapfrog Group’s CEO, Leah Binder, said “the use of CPOE is ‘growing slowly’ at U.S. hospitals… Even with the promise of billions of dollars in incentives from the HITECH Act’s programs for the meaningful use of health IT, ‘we’re still not yet seeing a level of adoption or advancement of CPOE’ that makes effective use of the technology the rule rather than the exception.”
It can be argued that CPOE is bigger (at least marginally) than it used to be in terms of the technology’s presence within hospitals. But is CPOE really any better today than it was during all those years it spent in the health care IT wilderness?
The question is not academic. If hospitals are to reach and surpass the proposed stage 2 meaningful use threshold for CPOE usage – 60% of all medication, lab and radiology orders – it’s going to require a lot of physicians, doing a lot of electronic order entry, for a lot of patients. And the only way that many physicians will play CPOE ball is if the software saves them time, and is really easy to use. Specifically, that means:
- Don’t force physicians to change how they practice medicine to accommodate the design of the software;
- Give physicians the flexibility to place orders on their smartphones and tablets, in addition to computers;
- Implement CPOE that can work with existing hospital systems, so physicians don’t have to wait (perhaps years) for completion of a massive hospital IT overhaul to begin entering orders electronically.
Unfortunately, not many CPOE systems meet these criteria for physician ease-of-use – which gets back to the question of whether today’s CPOE software is significantly better than what physicians rejected in the past. With a few exceptions, the answer is no. Until it is, CPOE may continue its slow crawl up the adoption curve, but it is unlikely to garner a level of physician adoption beyond the stage 2 minimum. While 60% is far better than 30%, neither represents the sustained, high level of physician adoption that ultimately will yield the efficient clinical workflow, improved patient safety and decreased costs that have long been the promise of CPOE.