Physician group leaders looking to bring the benefit of computerized physician order entry to their clinics and practices should plan to spend up to $29,000 per doctor to install and up to $12,000 a year to maintain a top-end ambulatory CPOE system, according to a new study of ACPOE systems.
Physician executives can expect dramatic improvements in error reduction and financial performance from a high-quality ACPOE system that will include many of the functions of an electronic medical records system, according to Blackford Middleton, M.D., a co-author of the study.
The systems could prevent 2 million adverse drug events a year, including 130,000 life-threatening events annually, and save the U.S. healthcare system $44 billion a year in reduced medication, radiology, lab and ADE-linked costs. The researchers also project that, for every five years of use of an ACPOE system, a provider could expect to avoid four patient hospital admissions and three life-threatening patient adverse drug events.
Middleton released details of the new study at the Health Information Management Systems Society meeting in San Diego. He is corporate director of clinical systems at Partners HealthCare System in Boston and serves as chairman of the Center for Information Technology Leadership, a not-for-profit research organization chartered by Partners that prepared the ACPOE report.
The report was based on a survey of existing literature, interviews with 35 healthcare information technology vendors and the work of an expert panel of physician leaders.
For a top-of-the-line or mid-range ACPOE system, physician leaders can look for a two-year payback on their investment if their practices carry an average level of capitated patients, about 11% of their patient mix.
Middleton says group leaders can spend less to install an ACPOE system, about $4,500 per physician, but should expect a much longer payback period.
"The bottom line is, the advanced system is the more expensive system, but the more expensive systems pay themselves back quicker," Middleton says.
A less expensive system also will be without several advanced clinical functions. For example, a lower-cost system would have medication decision support, but it would be a click-through to an electronic medical reference book, not an automatic system with complex and patient-specific checks for drug-drug, drug-allergy and drug-disease interactions.
These lower-priced systems also would not have diagnostic decision support features.
With capitation, the systems can save practices by lowering the cost of medication, improving utilization of radiology and lab work and reducing the number of adverse drug events.
The report says a typical provider using an advanced ACPOE system would save close to $28,000 a year, including more than $17,000 in medications, nearly $7,000 in radiology, $3,000 in lab costs and $1,000 from ADE-related hospital costs.
"In non-capitation, there's still savings, but they go to the payer," says Middleton, who argues payers should help defray the costs of ACPOE systems.
Even in non-capitated environments, however, groups should see financial benefits in more effective charge capture and a reduction in the frequency of rejected claims, he says.